When should a new practice start credentialing before opening?

At least 120 days out. Commercial payers take 90 to 120 days to approve a clean file, and you can't bill in-network until the effective date, so earlier filing directly protects your first months of revenue. Most new practices start with a free Qualigenix timeline review.

What do I need to file to credential providers for a new practice?

Individual (Type 1) and group (Type 2) NPIs, a complete and attested CAQH ProView profile per provider, active state licenses, DEA registration, and malpractice coverage. Those come first, then Medicare (PECOS), state Medicaid, and your commercial payer applications.

Can a new practice bill insurance before credentialing is done?

Not in-network. You can see patients, but an in-network claim only pays from the provider's effective date with each payer. Billing before that date means out-of-network rates or no reimbursement, which is the gap the 120-day lead time is meant to close.

How much does credentialing a new practice cost?

Industry pricing commonly runs $100 to $300 per payer per provider for initial credentialing, or a flat per-provider package when you're joining several networks at once. The larger cost is usually the unbillable days a late file creates, not the vendor fee. Qualigenix prices to your provider and payer count; ask for a quote.

Should a new practice outsource credentialing or do it in-house?

A new practice rarely has a credentialing specialist on staff at launch, so the trade-off is ramp time against fixed cost. Outsourcing gets the filings moving in days rather than weeks, which matters most when the 120-day clock is already running. Qualigenix onboards a new practice in 6 days.

How long does new-practice credentialing take?

Plan for 90 to 120 days for a clean commercial file, longer for Medicaid in some states and for multi-state or telehealth setups. Incomplete provider data or a lapsed CAQH attestation adds two to six weeks per correction cycle.

New Practice Credentialing: Start 120 Days Out

New Practice Credentialing: Start 120 Days Out | Qualigenix