What is the process for credentialing?

There are several phases of the credentialing process, and we are willing to help you with as many or as few of them as possible. Here is how we categorize the process:

1. Preparation: Gathering information about the provider to begin the credentialing process

2. Selection: Selecting which insurance companies to credential with from the list below

3. Contact: Creating a contact person with the insurance companies for submitting documents

4. Initial Submission: Sending over necessary paperwork for credentialing to each of the insurance companies discussed

5. Subsequent Submissions: Sending additional requested documents, clarifications, etc, to the insurance company as they request them.

6. Follow Up: Calling each contact at 30, 60, and 90 days to ensure the process is still in progress, and making sure no additional information is needed.

7. Finalizing: Finalizing all contacts, creating a document of passwords, website and portal logins, and a PDF copy of all documentation provided along the way

8. Re-Credentialing: Many insurance companies require you to renew your information annually, or in set intervals. If you have already credentialed, and need help completing the re-credentialing process, please make sure to provide the requests from the insurance companies.

9. Investigations: If you’ve started your credentialing yourself, and are not certain where things are at, and what else needs done, this category is for you. Let us take over and get you back on track.

10. Re-Organizing: Sometimes, providers are not certain of their networks, due to various circumstances. Re-Organizing is for locating network status amongst most payers, and gathering copies of contracts, fee schedules, and other forms that may be helpful in streamlining your billing process.

What will it cost?

UPDATED 11/01/2023

Discovery Call & Itemized Quote/Timeline: $75

Provider Set Up (Lifetime access for the individual NPI to Business Services): $200

Group Set Up (Lifetime access for the TIN to Business Services): $200

CAQH Profile Creation & Attestation: $100

CAQH Attestation/ Demographic Update: $75

Initial Application: $125 per company

Re-Credentialing: $125 per company

Group Applications: $125 per company

Demographic Updates: $75 per company

$75 due before Discovery calls are completed, and includes timeline for application, and process. This deposit ensures your position is held on my schedule. 1 Time Set Up due upon provider agreement of quote. All fees are due paid in full at the beginning of services.

An hourly rate of $60/hour may be applicable if credentialing or contracting is in process with minimal notes or record of completion, and for category #9 and #10 listed above.

What insurance companies do we help with?

The credentialing world holds a similar skeleton for most companies. The following are companies that we have worked with several times over again. If you do not see a company listed, it simply means it might take some additional research to begin the process. It is not an indication that we will not be able to successfully credential you. At this time, we have successfully obtained over 1,000 contracts in over 35 states.

  • Aetna
  • American Specialty Health (ASH)
  • Anthem
  • CHP (Kaiser’s Alternative Care Plan)– I no longer offer credentialing with CHP, Effective 09/06/2023
  • Blue Cross
  • Blue Shield
  • Blues (Local)
  • Cigna
  • Health Net
  • Humana
  • Lifewise
  • Medicare
  • Meridian
  • Meritan
  • Moda- I no longer offer credentialing with MODA, Effective 09/06/2023
  • Medicaid- varies based on state
  • Medicare
  • Optum
  • Providence
  • Tricare Select
  • United Healthcare

Credentialing services are offered solely by Jessica Moffitt, and are not affiliated with Dr. Dustin Moffitt or his practice as a medical doctor.

A word from Jessica:

First and foremost, thank you for trusting me with your practice. My work is largely based on referrals, and so your word is everything. Please feel free to discuss any concerns you may have along the way, and spread the word of my business to your fellow colleagues.

I currently provide services for the following specialties: MD, DO, NP, APRN, ND, DC, LMT, LAc, DPT, OT, ST and behavioral health providers, and RD’s.

Credentialing services are not guarantees of participation- Insurance companies regulate who can and cannot participate. However, I will do my best to get you listed as participating for every company that you wish to work with- or a denial letter stating why you cannot participate. I do not have a certification or degree specific to credentialing- but I do have 10 years of experience to help lead the way.

If you would like to begin the credentialing process, please contact us at prospectivelyhealthy@gmail.com.