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Provider-Credentialing-Service-FAQ

11/26/2013

1.    What is CAQH?

CAQH stands for the Council for Affordable Quality Health Care.  They host a universal credentialing database for health care providers.

For more detailed information please go: upd.caqh.org

2.    What is PECOS?

The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:

  • Submit an initial Medicare enrollment application
  • View or change your enrollment information
  • Track your enrollment application through the web submission process
  • Add or change a reassignment of benefits
  • Submit changes to existing Medicare enrollment information
  • Reactivate an existing enrollment record
  • Withdraw from the Medicare Program

3.    How long is the credentialing process?

The credentialing process generally takes between 90-120 days. When you sign up for credentialing with us, we waste no time getting your applications completed and submitted to insurance companies. Then, we follow up regularly with insurance companies to make sure that your credentialing applications are processed and approved as soon as possible.

4.    Can I start seeing patients before my credentialing is done?

No, provider cannot start seeing patients until Approval letter containing effective date and provider id is received from Insurance Company.

5.    Can I have past effective date on the contract?

No, Commercial insurances never give past effective date on the contacts. Medicare does not allow providers to submit an enrollment application more than 30 days prior to his/her start date.

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