What Are the Hidden Cost of Provider Credentialing Services?

Outsourcing credentialing services can streamline the complex and time-consuming process, helping your practice enroll providers more quickly and reduce stress. However, understanding the cost is essential to ensure it fits within your healthcare practice’s budget.

Credentialing costs can vary widely based on the services provided and the pricing model used by the enrollment and contracting service. To help you make the right choice, we’ve broken down the cost of handling credentialing in-house and outsourcing it to a third-party provider.

In this article, we’ll go over what medical credentialing services prices, including what to expect when outsourcing to a professional credentialing service.

Credentialing expenses within a practice can be broadly divided into two categories: “in-house” costs and “outsourced” expenses for both facilities and individual providers. It is important to note that the costs associated with verifying the enrollment effective date and following up with payers are not included, as these are primary sources of delays.

Direct Credentialing Costs are typically absorbed by the practice through dedicated personnel or staff in related departments, such as billing, responsible for credentialing. While internal tasks can be outsourced to a third party, provider interaction is still required to some extent. These costs mainly relate to time spent on tasks like populating applications, reviewing applications, collecting data and documents, responding to follow-up requests from contracting bodies, and completing paperwork.

Example of Direct Credentialing Costs:

• Physician ($163.96/hr): 3.4 hours = $557
• Support Staff ($19.50/hr): 31 hours = $604.50
• Technology & Hardware costs: $150

Total Per Physician Direct Costs: $1,161.50
Adding 30% for taxes and insurance, plus technology costs:
$1,509.95 + $150 = $1,659.95

What to Look for in Credentialing Services

When assessing credentialing & enrollment services, it’s essential to recognize that not all vendors provide the same level of support. “Completing enrollments” may range from merely submitting applications to offering thorough payer follow-up and guiding you through the enrollment process, including approvals, rejections, and denials. Be sure to ask questions, carefully review the contract, and make an informed decision.

Key Factors in Choosing a Credentialing Provider:

When evaluating enrollment service providers, healthcare organizations should focus on the following aspects:

Factor	Description
State-Specific Expertise	Ensure the provider is knowledgeable about specific state regulations and requirements.
Network Relationships	Providers with established relationships with insurance networks can often expedite the process.
Process Transparency	An online platform or portal that provides visibility into the credentialing status can enhance communication and trust.
Adherence to NCQA Standards	Ensuring compliance with standards from the National Committee for Quality Assurance (NCQA) is crucial for maintaining quality.
Turnaround Time	A fast, reliable turnaround time can prevent delays in revenue generation.
Flexibility and Scalability	The ability to adapt to changing needs as your practice grows is important.
Customer Support	Accessible support and a dedicated contact can make communication more efficient.
Comprehensive Reporting	Regular updates and detailed reports help track progress and identify any potential issues early.

How Much Does Outsourcing Physician Credentialing Services Cost?

Credentialing service pricing vary based on several factors, including:

• Current credentialing status
• Number of physicians being credentialed
• Practice growth rate
• Changes in insurance contracts and providers
• Additional services contracted from the credentialing provider

On average, physician credentialing services cost between $2,000 and $3,000 per year.

Breakdown of Costs:

Service	Cost Range
Individual Physician Credentialing	$100 to $200 per physician (varies by provider). Re-credentialing costs are typically similar.
CAQH Database	Initial setup: $200 to $500. Ongoing management: $50 to $100 per month, depending on service needs.
Insurance Panel Applications	Starts at $100 per application; costs can be higher depending on insurer requirements.

Benefits of Outsourcing Credentialing Services

Outsourcing credentialing services can streamline the process and mitigate internal workload. Professional credentialing companies are experienced in handling the complexities of insurance contracting and can manage tasks such as application submission, follow-ups with payers, and navigating the enrollment decision-making process. This expertise can prevent delays and reduce administrative strain on internal teams.

Factors Affecting Credentialing Service Costs

The cost of outsourcing credentialing varies based on multiple factors:

• Current Credentialing Status: Affects service complexity and pricing.
• Number of Providers: More providers increase total costs.
• Practice Growth Rate: Rapid growth may require frequent credentialing updates.
• Insurance Contract Changes: Alterations in contracts or providers impact costs.

Average Cost: Credentialing services typically range from $2,000 to $3,000 per physician per year, covering tasks like background verification, payer follow-ups, and complete management of the credentialing process. Re-credentialing, required periodically to maintain active status, often incurs similar expenses.

How Can Tranquil Credentialing & Enrollment Services Help?

Credentialing is a critical process for any healthcare practice, and outsourcing can provide a viable solution to reduce internal administrative burdens. Understanding the direct and outsourced costs involved and key service features to look for in a provider helps healthcare organizations make informed decisions.

By choosing credentialing and contracting services that align with their needs, practices can maintain compliance, ensure timely billing, and focus on patient care without the distractions of administrative complexities. Contact us at 1-(518) 413-1817.