Service & Price List

This includes submission & postage, tracking and signing up for various Medicare connect websites Noridian, PECOS, EDISS etc.

Processing time: About 6 months to a year for a decision.

Some companies first require a letter of interest before the Ins. Co. will extend you an application to join.

Processing time: About 90-180 days for a decision. 

Generally these applications are not difficult and done online. 

I fill out the forms and upload your documentation.

They usually do require you to build a profile with a picture.

 Processing time: About 30-60 days for a decision

The National Committee for Quality Assurance (NCQA), the principal accrediting entity for Managed Behavioral Healthcare, requires intensive file review, oversight and continual monitoring of healthcare organization policies and procedures for practitioner network inclusion and maintenance.  To meet this requirement, most insurance companies requires that you submit your credentialing info via CAQH.  So start by getting your free account: https://proview.caqh.org/PR/Registration

The requirement varies per insurance company. But the general requirements are that you have :

• 2 years experience in your field (pre-license experience counts)
• You are licensed with the state (in good standing) 
• A NPI # and are registered on NPPES   https://nppes.cms.hhs.gov/
• A city business license for each city you work in
• Liability insurance 
• No felony criminal record or pending charges

$200.00 a month for the first 4 hours and then  $25.00 an hour. There is a 4 hour minimum a month which allows for up to 24 claims or tasks.

Guesstimate for average Solo providers with a small practice of about 15-20 active patients/clients will require about 

• up to 24 Claims/Tasks if billing once a month the labor only fee $200 a month. You pay for clearinghouse service fee.

• up to 50 Claims/Tasks if billing every two weeks Labor only fee is about $400 a month.

Service fees are charged by the clearinghouse you use to submit the claims. In the healthcare industry, a clearinghouse is an institution that electronically transmits different types of medical claims data to insurance carriers.

Office Ally, for example, is $0 to $35.00 a month and SimplePractice starts at $99.00 a month.

A claim, statement or benefits verification is a task. 

Note: A benefits verification takes about 10 min for online verification but calling the company by phone takes 15-60 minutes.