Managed care means credentialing holdups

Physicians often wait months for HMOs to process credentials. Delays cost doctors in lost revenues and scheduling problems.

By Jay Greene, AMNews staff. Feb. 4, 2002.

Muhammad Wasim Sadiq Ali, MD, a neurologist in Jasper, Ala., spent a year waiting for Blue Cross and Blue Shield of Alabama to approve his managed care credentials. Dr. Ali hired a lawyer to move the application process along.

Michael DeBevec, MD, a family physician in Duluth, Minn., practiced sports and general medicine for nearly 20 years until he had to drop his sports medicine practice after United Healthcare required him to be board certified.

Thomas Blevins, MD, an endocrinologist, waited weeks to be re-credentialed with some payers after leaving a large group and setting up practice in Austin, Texas. Then he had to reschedule appointments with patients while he haggled over managed care contracts.

Hassles like these with managed care payers are all too common and require legislative and regulatory fixes, said Paul Friedrichs, MD, a urologist in Washington, D.C., and AMA Young Physician Section delegate.

"We've heard of it taking six months to get credentials and listed on panels," Dr. Friedrichs said. "Because of delays in credentialing, physicians are not getting paid or cannot even practice."

As physicians incur larger medical training debt and become more mobile, licensing and credentialing delays in setting up practices can cause serious financial problems, said Patrice Burgess, MD, a Boise, Idaho, family practice physician and YPS chair-elect. "Doctors are moving more now due to spouse and other issues. They aren't setting up practice for 30 years and staying. ... They are in huge debt, and then it takes them months for money to start flowing in from payers if they have credentialing delays." [...]