Rates

Direct Credentialing Costs

Direct credentialing costs are primarily absorbed by the practice through dedicated personnel or outsourced to a third party. Even when outsourced, there is still some level of interaction required from the provider. These costs typically involve time spent gathering and submitting provider information, tracking down necessary documents, responding to credentialing inquiries, and reviewing applications.

• Credentialing Specialist ($150/hr): The service package includes primary source verification, application submission, and follow-up, costing $3,000 per provider. The cost includes time spent coordinating between different credentialing bodies and ensuring timely follow-ups.
• Re-Credentialing Services ($150/hr): This includes updating documentation, renewing credentialing with payer organizations, and verifying current information, billed at $150/hour.
• Primary Source Verification ($150/verification): This involves direct verification of provider qualifications, licensure, and education from issuing authorities, billed at $150 per verification.
• Technology & Hardware Costs: Associated with maintaining the necessary infrastructure to support credentialing operations, estimated at $150.

Total Per Provider Credentialing Costs:

• Credentialing Specialist: $3,000
• Technology & Hardware Costs: $150
• Taxes and Insurance (30%): $945
• Total: $4,095 per provider for complete direct credentialing.

Billing Costs

Billing costs stem from the lost revenue due to the inability to bill for services during the credentialing period. Depending on the payer, credentialing can take between 45 to 182 days. During this period, practices may experience financial loss as they are unable to bill insurers for services provided.

Credentialing lag times are influenced by various factors such as the type of practice, the specific requirements of each payer, and the complexity of the applications.

Credentialing Service Competitors

Credentialing service costs vary by provider and package. Below are the average prices from competitors:

• PPS: Credentialing packages average $200 per plan per provider, offering discounts of 10-20% compared to competitors.
• ThriveWorks (medicalcredentialing.org): Counseling credentialing services costing $325 per plan per provider.
• Supero Healthcare: Medicare and Medicaid credentialing costs $375 per provider, with commercial plans averaging $250 per plan per provider.
• National Credentialing (nCred): Most plans are priced at $275 per plan per provider.

Service Packages:

1. Basic Credentialing Package:
   Description: Initial credentialing and verification for one provider, including primary source verification, application submission, and follow-up.
   Price: $3,000.00 per provider

2. Re-Credentialing Service:
   Description: Renewal of existing credentialing with payer organizations, including updating documentation and verifying current information.
   Price: $150.00 per hour

3. Primary Source Verification:
   Description: Verification of provider’s qualifications, education, and licensure directly with issuing authorities.
   Price: $150.00 per verification

4. Payor Enrollment:
   Description: Enrollment and contracting with individual insurance payers, including application submission and follow-up.
   Price: $3,000.00 per payer

5. Custom Services:
   Description: Tailored credentialing services based on specific needs, including CAQH enrollment, Governmental carrier applications, NPI application/enrollment.
   Price: Variable or $250/hour

Additional Fees:

• Rush Service: $350/hr (for expedited processing)
• Provider Termination from Insurance Company: $50 per termination
• Network Research for Participation/Carrier: $35 per provider
• Travel Expenses: (if applicable, billed separately)