An interview with Josh Plummer, President and CEO of PracticeWorx.

What does PracticeWorx do for healthcare practitioners and organizations?

We are credentialing experts that work with all types of practitioners and organizations who need to enroll as in-network providers with insurance plans. And for many of our clients, we become their own “in-house” credentialing department handling all their credentials-related needs: maintaining credentials such as licensure, certifications, hospital/facility privileges and CAQH profiles, as well as re-credentialing with insurers.

What is the most common misconception about provider enrollment and credentialing?

The length of time it takes to initially enroll/credential with an insurer.  Although varied by insurance company, the average time to enroll a practitioner right now is 90 days, and that’s from the date a complete and correct application is submitted to the insurer. Commercial insurers are not held to any regulation when it comes to the credentialing of a new practitioner. So we have to stay in continual communication with the representatives from each insurer to make certain they are actively working the enrollment of our client.

What are the risks for not maintaining proper credentials?

The most frequently occurring risk is being dropped or termed as an in-network provider by an insurer, and thus the loss of patients and patient revenue. The accreditation standards for insurers require the insurers to continually monitor that all their network providers maintain current and active credentials. So it is vital for a practitioner to keep their CAQH profile up-to-date and respond to any re-credentialing requests from the insurer otherwise they run the risk of losing their in-network status.

What do you enjoy most about working with your clients?

Clients come to us because they need assistance with managing their credentials and enrolling with insurance companies. Knowing that we play a role in the success of their practice is why I enjoy what we do. And many times these practitioners are starting their very first practice. So I always try to go beyond the credentialing and payor enrollment to provide them with guidance and suggestions to make sure they set up their new practice correctly. Being able to provide this additional support to a very appreciative practitioner is very rewarding.