Are you a healthcare provider practicing in New York State (NYS) and trying to expand your patient base by becoming in-network with major insurance companies?
If yes, you must not ignore Healthfirst. It is a not-for-profit health insurance carrier founded by New York’s leading hospital systems. It takes a hyperlocal approach by providing health insurance plans that suit every stage of life for individuals in Long Island, Westchester, Hudson City, and New York City.
This guide covers everything you need to know about Healthfirst credentialing, from its process to requirements, challenges, and best practices. So, continue reading!
A Step-by-Step Guide to the Healthfirst Credentialing Application
Follow the steps below to get credentialed with Healthfirst:
Step # 1: Create or Update CAQH Profile
Similar to many other insurance companies in the US, Healthfirst also utilizes the Council for Affordable Quality Healthcare (CAQH) to verify provider credentials and primary source verification. Thus, consider it a prerequisite to create or update your CAQH ProView profile.
Once done, authorize access to Healthfirst.
Step # 2: Submit Credentialing Application
Go to the Join Our Network page. Complete the Healthfirst credentialing application and submit it.
Step # 3: Review & Verification
When the Healthfirst credentialing team receives your application, they start the review process.
It primarily involves your credential verification from your CAQH profile, the National Practitioner Data Bank (NPDB), and other regulatory bodies.
Step # 4: Approval
Upon successful completion of the primary source verification, Healthfirst sends you a participation agreement to sign. You sign it, and you officially become an in-network provider with the carrier.
Healthfirst Provider Credentialing Requirements
You must fulfill the following Healthfirst credentialing requirements to ensure successful enrollment with the insurance carrier:
| What Is Needed? | Description |
|---|---|
| CAQH Profile | An active, updated, and attested CAQH ProView profile is required for primary source verification. Also, you must authorize access to Healthfirst. |
| National Provider Identifier (NPI) | You must provide a valid Type 1 NPI (individual) and Type 2 NPI (group), i.e., registered through the National Plan and Provider Enumeration System (NPPES). |
| Active NYS Medical License | You must have an active, unrestricted license to practice medicine in NYS. |
| Federal DEA Registration | It is mandatory for healthcare providers who prescribe controlled substances. |
| Professional Liability Insurance | You are required to submit a certificate of insurance (COI). |
| 5-Year Work History | Your resume must detail your 5 years of consecutive work experience in MM/YY format. Additionally, you must offer a written explanation for any practice gaps. |
| Hospital Privileges | You must submit a list of current hospital affiliations, admitting privileges, and transfer agreements. |
Challenges in Getting Credentialed with Healthfirst
Listed below are some of the challenges clinicians encounter during the Healthfirst insurance credentialing journey:
- In cases where clinicians forget to grant access to Healthfirst to the CAQH profile, it can cause significant application processing delays. The reason? Healthfirst utilizes CAQH to extract provider data for credentialing.
- If the provider data across CAQH and NPPES does not match, it can result in Healthfirst credentialing application rejection.
- Unexplained practice gaps can reduce your chances of becoming in-network with Healthfirst.
- The entire credentialing process typically takes around 90 days to complete. Thus, if you fail to respond to credentialing committee queries, the timeline can stretch further. The outcome? This prevents you from seeing Healthfirst beneficiaries.
Best Practices for Healthfirst Insurance Credentialing
Implement the following effective strategies to expedite the Healthfirst credentialing process:
- Create a digital repository of all your current and active certifications, licenses, and other documents for easy access.
- Set automatic reminders to update and re-attest your CAQH profile every 120 days.
- Before initiating the Healthfirst credentialing request, authorize access to your CAQH profile.
- Start the process at least 90 days before you plan on rendering services to the Healthfirst beneficiaries.
- Never render services to Healthfirst patients before the contract effective date, as it will result in automatic denials.
- Reconcile your data across CAQH and NPPES systems to ensure there is no misalignment.
Bonus Tip: Outsource Healthfirst insurance credentialing services to professionals at MediBillMD at affordable rates.
Streamline Healthfirst Credentialing With MediBillMD
Hopefully, with this guide as your go-to resource, your Healthfirst credentialing journey will be smooth. To summarize, you need an active CAQH ProView profile, the credentialing application must be submitted by visiting the ‘Join Our Network’ page, and prompt replies must be sent to queries from the Healthfirst team.
On average, the entire process takes up to 90 days, given that all your provided details, certifications, and licenses are active, valid, and up to date.
At MediBillMD, we help healthcare providers across all 50 states get credentialed with almost every insurance payer they ask for. Thus, if you want to partner with us, simply schedule a call with our representative to discuss details and the pricing model.
