CREDENTIALING

Prior to allowing network participation, insurance plans require that healthcare professionals engage in the process of credentialing. The IPA offer support to try and help push these credentialing documents through in a timely manner. While the NMAC regulation states the plan is to have 45 days to verify licenses and all other information to accept a new provider in their network, many times the plans take longer. Delegated Credentialing is when an office like the GMIPA  becomes “delegated” by a plan to do all the work in advance, and notify the plan to load the provider in their network once those verifications are complete.

Delays can occur from credentialing documents expiring in the process and “lost” or neglected applications. Providers who see patients between the time they submit their credentialing information and the time they are finally approved, may result in reimbursement shortages or denials for services in the interim. Reliable, streamlined credentialing processes can save providers and practices significant time and money, giving them more freedom to serve their patients. The GMIPA office aims to become delegated with all its plan partners over time, alleviating providers from having to complete multi-page packets and communicate with multiple entities.

Contact the GMIPA office at 575-538-2355 or email for more information on delegated credentialing services.