How to get providers provisionally credentialed by payers

Q: How can I get my providers provisionally credentialed by payers?

Amy Niehaus, CPMSM, CPCS, MBA: Provisional credentialing is an option available to payers under National Committee for Quality Assurance (NCQA) and CMS for managed care, but it’s still up to the payers to decide whether they’re going to utilize this process. It has to be outlined in their policies and procedures and if they do offer it, they may also have additional criteria other than what NCQA requires. You would need to reach out to your payers individually. 

If you have a practitioner you’re trying to bring on very quickly because you have an immediate need to fill a gap, ask if your payers allow for provisional credentialing and see what they require to do that. In my experience, there are payers that do allow for provisional credentialing, but many of them do not. It may  be the payer’s preference to just complete the whole process all at once rather than doing a provisional step.

Source: News & Analysis