Understanding a U.S. health insurance plan is no simple feat, but the credentialing process is even more complex for healthcare professionals. To practice, physical therapists (PTs) must provide proof of insurance or enrollment in federally funded programs like Medicare before seeing patients.
At MEG, we specialize in physical therapy credentialing services, helping PTs by removing the application burden, avoiding unnecessary delays, and securing approvals faster.
The Credentialing Process for Physical Therapy
If you’re a newly graduated PT or opening a private practice, credentialing is a critical first step. The process includes:
- Applying for an NPI number (National Provider Identifier)
- Completing a CAQH application (Council for Affordable Quality Healthcare)
- Enrolling in Medicare (separate from commercial insurance applications)
- Contracting with private insurance carriers (each with its own unique requirements)
If done incorrectly, this process can lead to unnecessary delays. One of the most common questions we receive is: “How do I get started with credentialing?” The first step before anything else? You must have a physical practice location in place to enroll in a wider selection of insurances. While some commercial insurances offer contracts for mobile PT practices, having a brick-and-mortar location provides more enrollment opportunities.
When Is the Right Time for Credentialing?
The best time to start credentialing is before you begin seeing patients. Since the process can take several months, starting early ensures you’re ready to accept insurance payments without delays.
Credentialing timelines vary based on several factors. First, whether you’re applying as an individual provider or part of a group practice can affect processing time, as group credentialing often takes longer. Additionally, insurance carriers have different review times, with some responding faster than others. Another key factor is network panel availability—if a panel is open, approval may be faster, but if it’s closed, alternative options may be necessary.
To remain in compliance, PTs are required to begin credentialing any new treating physical therapist (new hire) within 3-4 months of their hire date. Failing to do so can lead to delays in reimbursement and potential compliance issues with insurance providers.
Estimated Credentialing Timelines
- Private insurance approvals typically take 60-120 days from the date of application submission.
- Insurance carriers may take up to 45 business days to confirm availability in their network.
- The full credentialing process generally takes 3 to 6 months for new private insurance contracts (potentially shorter when adding a provider to an existing group contract); Medicare enrollment typically takes 15-35 days (with backdated claims), while Medicare reassignment can be completed in 5-30 days.
If a network panel is closed, you may still have options. Some providers choose to become certified with insurance companies without full network participation, while others enroll as out-of-network providers and continue treating patients while working toward in-network approval.
Since errors or missing documents can cause costly delays, working with a professional credentialing service ensures that all paperwork is completed correctly the first time, keeping your timeline on track.
How to Speed Up the Credentialing Process
Our expert physical therapy credentialing specialists follow key strategies to keep things moving efficiently:
- Start with a contracting strategy
- Before submitting applications, our credentialing officers call each insurance carrier to understand their process and availability.
- Stay organized and track submissions
- Credentialing experts conduct weekly follow-ups via phone calls and emails to check the status of applications.
- Use secure and trackable submission methods
- Most insurance companies now require applications to be submitted online. Utilizing secure online portals ensures faster processing, reduces paperwork errors, and allows for easy tracking of submission status.
- Work with an experienced credentialing partner
- A reliable credentialing company proactively handles delays and ensures close communication throughout the process.
While it may cost a bit more, choosing a quality credentialing service can save you months of frustration—allowing you to focus on treating patients instead of paperwork.
How to Get Approved Faster for Closed Insurance Panels
If an insurance panel has limited space for new providers, you may still improve your chances of approval by demonstrating your unique value. Most insurance companies revisit their panel status every 3-4 months, so staying informed and prepared can help you secure a spot when openings become available.
- Provide Specialized Services
- If your PT practice offers treatments that no one else provides within 5-10 miles, insurance companies may be more likely to approve you.
- Submit Letters of Recommendation
- Letters from referring physicians and patients can highlight the demand for your services.
- Leverage Advanced Techniques
- If your practice uses cutting-edge physical therapy techniques or technology, emphasize this when speaking to provider representatives.
These strategies can significantly improve your chances of gaining insurance approval, even when network panels are limited.
Why Choose MEG’s Physical Therapy Credentialing Services?
At MEG, we help PTs get credentialed quickly and efficiently, avoiding common pitfalls that lead to denials and delays. We provide:
- Personalized guidance through the entire credentialing process
- Dedicated follow-up team to keep applications on track
- Fast-tracked submissions for quicker approvals
- Support for new practice owners looking to streamline startup credentialing
If you’re a practice owner looking to get your physical therapy credentialing handled by a team of experts, let us handle the process—so you can focus on patient care and growing your practice.
