Provisional Credentialing

With many medical practices utilizing telemedicine in the recent months, many questions have come to light.

“Is my technology adequate?”

“Am I properly credentialed to perform telemedicine?”

“How and when will I be reimbursed for my services?”

It was recently announced that select payers will “provisionally credential” providers during the COVID-19 outbreak. This essentially means that providers can see patients via telemedicine without being traditionally credentialed under the existing regulations. It’s been said that provisional credentialing may also make it easier for out-of-network independent providers to join a payer’s network.

Think of it as a streamlined process for expedited credentials.

So how will potentially moving approval dates forward and processing applications on the back end affect how care is provided? Practitioners would be able to see patients and provide care without being tied down by the long processing times and state-based limitations that currently exist. The benefit is obvious. Medical practitioners to provide immediate care – something that is critical in this current time.

While this process will allow claim payment processed to be accelerated, physicians will still need to gain the proper credentials after the provisional period ends. Providers need to get their credentialing right the first time to prevent denials on the back end. If a payer finds an issue with an application, claims may be denied.

As is common during the COVID-19 crisis, the rules and procedures are unknown and in many cases are being revised regularly.  So how can practitioners set up provisional status with payers and eventually gain proper full credentials? Stay up to date on the latest updates regarding provisional credentialing on the TPS COVID-19 resources page.

For more information on credentialing services, click here.