Why Credentialing Matters for Your Medical Practice
If you run a medical practice in New Mexico then you already know how much paperwork and administrative work comes with the job. One of the most important tasks that many providers overlook is credentialing. Without proper credentialing your practice cannot get paid by insurance companies. It is that simple. And when credentialing is delayed or done incorrectly it can cost your practice thousands of dollars every single month.
At EZE Medical Billing Services we help medical providers in New Mexico handle their credentialing from start to finish. Our team takes care of the entire process so you can focus on what you do best which is taking care of your patients.
What Is Medical Credentialing
Medical credentialing is the process of verifying that a healthcare provider meets all the requirements set by insurance companies and government health programs. Insurance companies want to make sure that every doctor nurse practitioner physician assistant and other healthcare provider in their network is qualified and licensed to practice medicine.
This verification process includes checking your education your training your licenses your work history and your malpractice history. Once you are credentialed with an insurance company they add you to their network. After that your patients can use their insurance to pay for your services and you get reimbursed for the care you provide.
Without credentialing you simply cannot bill insurance companies. That means your patients would have to pay out of pocket for everything. Most patients cannot afford that and they will look for another provider who is in their network. This is why credentialing is so important for any medical practice.
The Credentialing Process in New Mexico
New Mexico has its own rules and requirements when it comes to medical licensing and credentialing. Every provider must hold a valid New Mexico medical license before they can be credentialed with insurance companies in the state. The New Mexico Medical Board handles physician licensing while other boards handle licensing for nurses and other providers.
Once you have your state license you need to apply for credentialing with each insurance company you want to work with. In New Mexico this includes major payers like Blue Cross Blue Shield of New Mexico Presbyterian Health Plan Molina Healthcare New Mexico Medicaid and Medicare.
Each insurance company has its own application process and its own timeline. Some companies take 60 days to complete credentialing while others can take 90 to 120 days. During that waiting period your claims cannot be processed. This is why it is so important to start the credentialing process early especially when you are opening a new practice or adding a new provider to your team.
At EZE Medical Billing Services we know how each insurance company in New Mexico works. We know what documents they require and what their timelines look like. We track every application so nothing gets lost and you always know exactly where things stand.
Common Credentialing Challenges
Credentialing sounds straightforward but it is actually one of the most complex parts of running a medical practice. Here are some of the challenges that providers face when they try to handle credentialing on their own.
Missing or incomplete documents are the number one reason applications get delayed. Insurance companies require a lot of information including your National Provider Identifier number your DEA certificate your malpractice insurance certificate your license copies your board certifications and much more. If even one document is missing or expired the insurance company will put your application on hold and you will have to start over.
Following up with insurance companies takes a lot of time. Most payers do not proactively update you on the status of your application. You have to call them yourself and navigate through different departments to find out where things stand. This can take hours every week and it pulls your staff away from other important work.
Re credentialing is another challenge that many practices do not prepare for. Every insurance company requires providers to go through re credentialing every two to three years. If you miss a re credentialing deadline your contract with the insurance company can lapse and you will have to reapply as a new provider. That means more delays and more lost revenue.
New providers joining your practice need to be credentialed before they can see insured patients. If you bring on a new doctor or nurse practitioner and they are not credentialed yet your practice loses the revenue from their patient visits until the process is complete.
How EZE Medical Billing Services Handles Credentialing
When you work with us we take complete responsibility for your credentialing. Here is how our process works.
First we sit down with you and review your current situation. We look at which insurance companies you are already credentialed with and which ones you still need to apply to. We also check your existing contracts to make sure all your information is up to date.
Next we gather all the documents and information that the insurance companies need. Our team knows exactly what each payer requires so we make sure every application goes out complete and correct the first time. This reduces delays significantly.
Once the applications are submitted we track every single one. We follow up with insurance companies regularly so we always know the status of each application. If a company asks for additional information we handle that immediately. You do not have to worry about missing a request or letting something fall through the cracks.
We also keep track of your re credentialing dates. We start the re credentialing process well in advance so your contracts never lapse. You will never have to worry about losing your network status because of a missed deadline.
Throughout the entire process we keep you informed. You always know what is happening and where each application stands. We make the whole process transparent and easy to understand.
Who Needs Credentialing Services in New Mexico
Our credentialing services are designed for a wide range of healthcare providers across New Mexico. Whether you are a solo practitioner a group practice a clinic or a hospital our team can help.
Physicians of all specialties need credentialing including primary care doctors specialists surgeons and more. Nurse practitioners and physician assistants also need to be credentialed separately even if they work under a supervising physician. Mental health providers including therapists counselors and psychiatrists need credentialing if they want to accept insurance. Physical therapists chiropractors and other allied health providers also need to go through the credentialing process.
New practices opening in New Mexico have the most urgent need for credentialing services because they cannot see insured patients or receive reimbursement until credentialing is complete. Getting started early is critical.
The Cost of Not Having Proper Credentialing
Many practices try to handle credentialing themselves to save money. But the cost of doing it wrong is much higher than the cost of having a professional handle it for you.
Delays in credentialing mean delays in getting paid. If a new provider in your practice is not credentialed for 90 days that could be three months of lost revenue. For a busy provider that could easily add up to tens of thousands of dollars.
Errors in applications can cause even longer delays. If an application is rejected because of a mistake you have to start the whole process over. That could add another 60 to 90 days to your wait time.
Letting a contract lapse means you have to reapply as a new provider. Insurance companies treat you the same as a brand new applicant which means you go to the back of the line.
When you work with EZE Medical Billing Services you avoid all of these costly mistakes. Our team gets your applications right the first time and keeps everything on track so your revenue is never interrupted.
Why Choose EZE Medical Billing Services
We are not just a billing company. We are a full service revenue cycle management company that understands the unique needs of medical practices in New Mexico. Our team has years of experience working with New Mexico insurance companies and we understand the local market better than anyone.
We are committed to providing personalized service. When you call us you talk to someone who actually knows your account. We answer your questions quickly and we keep you informed every step of the way.
Our goal is simple. We want your practice to get paid faster and with fewer headaches. Credentialing is just one piece of the puzzle but it is a critical one. When credentialing is handled correctly everything else in your revenue cycle runs more smoothly.
Frequently Asked Questions About Credentialing Services in New Mexico
What is medical credentialing and why do I need it?
Medical credentialing is the process where insurance companies verify that you are a qualified and licensed healthcare provider. You need it because without being credentialed you cannot bill insurance companies for the services you provide. If you are not in an insurance company network your patients have to pay everything out of pocket which means most of them will go to a different provider who accepts their insurance.
How long does credentialing take in New Mexico?
The timeline varies depending on the insurance company. Some payers complete credentialing in 60 days while others like Medicaid and larger commercial insurers can take 90 to 120 days. This is why we always recommend starting the process as early as possible especially if you are opening a new practice or hiring a new provider.
Can I see patients while my credentialing is still in process?
You can see patients but there is a risk. If your credentialing is not yet approved and you submit claims those claims will be denied. Some insurance companies offer retroactive billing which means once you are credentialed they will process claims from a backdated start date. But not all payers do this and it is never guaranteed. The safest approach is to wait until credentialing is fully approved before billing insurance for patient visits.
What documents are needed for credentialing in New Mexico?
The exact list depends on the insurance company but generally you will need your New Mexico state medical license your National Provider Identifier number your DEA certificate your malpractice insurance certificate your board certifications your curriculum vitae your work history for the past ten years and your educational background. Some payers also ask for hospital affiliations and peer references. Our team at EZE Medical Billing Services handles all document collection so you do not have to figure this out on your own.
What is re credentialing and when does it happen?
Re credentialing is the process of renewing your credentials with an insurance company. Most payers require this every two to three years. They want to make sure your license is still active your malpractice insurance is still valid and your information is still accurate. If you miss a re credentialing deadline your contract with that insurance company can lapse and you will have to reapply as a brand new provider which means going through the full waiting period all over again.
What happens if my credentialing application is rejected?
Rejections usually happen because of missing documents expired information or errors in the application. When an application is rejected the insurance company puts it on hold and you have to resubmit everything correctly. This can add another 60 to 90 days to your wait time. When EZE Medical Billing Services handles your credentialing we make sure every application goes out complete and accurate the first time to avoid these costly delays.
Do new providers in my practice need to be credentialed separately?
Yes. Every provider in your practice must be individually credentialed with each insurance company. Even if your practice already has an existing contract with a payer a new doctor nurse practitioner or physician assistant joining your team needs to go through their own credentialing process before they can bill insurance under your practice.
Do I need to be credentialed with every insurance company?
You only need to be credentialed with the insurance companies that your patients use. In New Mexico the most common payers include Blue Cross Blue Shield of New Mexico Presbyterian Health Plan Molina Healthcare New Mexico Medicaid and Medicare. We can help you figure out which payers make the most sense for your practice based on your patient population and your specialty.
How much does credentialing cost?
Most insurance companies do not charge a fee to credential providers. However the cost comes in the time and resources it takes to manage the process. Handling credentialing in house means your staff spends hours gathering documents following up with payers and tracking deadlines. Outsourcing to EZE Medical Billing Services saves that time and reduces the risk of costly errors and delays.
How do I get started with EZE Medical Billing Services?
Getting started is simple. Just reach out to our team and we will review your current credentialing status and figure out exactly what needs to be done. We handle everything from there so you can focus on your patients.
Get Started Today
If you are struggling with credentialing or if you are opening a new practice in New Mexico we are here to help. Do not wait until you have already lost revenue to take action. The sooner you start the credentialing process the sooner your providers can start seeing insured patients and getting reimbursed.
Reach out to EZE Medical Billing Services today and let us take credentialing off your plate.
Email us at info@ezemedbills.com
Call us at +1 505-903-2759
We look forward to helping your practice grow and succeed in New Mexico.