If you have an existing contract with a medical insurance payer (medicare, medicaid, commercial payers, etc.) we can get you set up to bill through our platform in 10-14 business days. If you would like to get those contacts as part of the set up, it will take closer to 3-6 months - with Medicare/Medicaid tending to be on the quicker end, and commercial payers taking longer to process applications.
The good news is your reaction time can really shrink this timeline. If you are quick to gather and submit the information needed from you, it does a lot to cut this timeline down. Below you’ll see a very basic timeline of the steps needed, with time estimates for each. We have highlighted the steps that need to be taken by your team in yellow, so you can be aware of the opportunities you have to make this process move as swiftly as possible.
Step 1 Onboarding Form (3 business days)
First thing, we will send you an Onboarding Form to collect all of the information about your pharmacy that we need to get the process started. When you fill out the Onboarding Form, be as thorough as possible to speed up all of the following steps.
Step 2 Obtain a Type 2 NPI & Update Existing Accounts (5 days)
You likely already have a Type 2 NPI for your pharmacy, but you will need one dedicated to medical billing through Workflow Services. This enables us to give you a transparent view of claims filed through our software. Send us your new Type 2 NPI as soon as you receive it. In the meantime we will already have begun Step 3.
There are rare exceptions to this step - if you already have a Type 2 NPI that is not being used for any other services, we can use that from the jump.
The last part of this step is for you to share your new NPI with your payers. You'll need to add your new type 2 NPI to your Medicaid account and update any payers you already have commercial contracts with.
Step 3 Account Information Verification (4-5 days)
Immediately following Step 1, our team will verify the information you’ve provided. If we need any additional information or clarification, we’ll send you an email requesting that. Please respond as quickly as you can.
Step 4 Credentialing (90-120 days)
This step is only for pharmacies looking to get new contracts, if you already have the contracts you need, skip to step 6 (and skip the bulk of the wait time).
This step is highly dependent on the speed at which each payer is able to process your application for a new contract - for Commercial payers this is typically 90-120+ days, a PTAN and/or Medicaid credentialing project should take between 30-45 days.
At times payers will have questions about information on the application which may require some back and forth to finalize. We will communicate these requests to you, quick responses on your part will really speed this step up. Our goal is to get you that contract as quickly as possible.
Step 5 Sign Payer Contract(s) (2-4 days)
Look over the contract you receive, sign it and send it back to the payer. Let us know when it has been signed, so we can update your account to reflect that you are now in-network with them.
Step 6 Final Platform Configuration (2-10 days)
Once the contract is secured, we will confirm the communication lines are open between our system and the payer, then turn medical billing on in our platform and let you know you are ready to start submitting medical insurance claims. This time frame is payer dependent with an ideal response of 2-10 days.
If you are getting credentialed with multiple payers, we can turn them on in the platform as contracts are signed and communication is established, you do not have to wait for them all to come in to start billing the payers you have contracts with.
Congratulations you are now ready to submit claims! Read more about how to do just that here: Getting Started with Medical Insurance - Collecting Insurance & Payment
More Related Articles:
What Information Is Needed for Medical Billing and Why?
Understanding NPIs and How They Relate to Pharmacy Billing
Note: Any question you email us along the way will be answered within 1 business day (usually even more quickly) to keep things moving along speedily.