Medical Credentialing Services in New Jersey

Amanda Cordova
New Jersey outline over a photo of doctors walking

Medical credentialing in New Jersey is a crucial step for healthcare providers seeking to work within hospitals, healthcare facilities, or with insurance networks. The process typically takes around 60 days (as of the writing of this article) and recredentialing happens every two to seven years, depending on the payer. Both licensing and credentialing processes are pivotal in upholding the integrity and safety of healthcare delivery in the state of New Jersey.

The New Jersey State Board of Medical Examiners oversees medical credentialing and licensing within the state. Healthcare providers, including physicians, physician assistants, and nurses, must submit a comprehensive application that includes their educational background, training, licensure, and work history.

What’s Unique About Medical Credentialing in New Jersey

Horizon NJ Health Requirements

Horizon NJ Health is New Jersey’s largest insurance provider and requires the most documentation for provider enrollment. Multiple agreements are required from providers, as well as a letter of intent, and a statement of collaboration. Identifying and collecting the required documents well in advance of your submission will help you to ensure the provider is enrolled in a timely manner.

Medicaid Proof of Submission Required

NJ FamilyCare, New Jersey’s Medicaid, requires proof of submission for enrollment if the provider does not include a Medicaid ID in the application. Since there are multiple forms and a very specific process to follow, you may want to call New Jersey Medicaid prior to starting the enrollment process just to be sure you’re completing the correct information.

Controlled Substance Licensure

New Jersey has a two license requirement for controlled dangerous substances. There is a $40 application fee and you can expect initial and renewal applications to take two to three weeks for processing if emailed (four to six weeks if mailed).

Steps To Complete Provider Credentialing in New Jersey

Here are the general steps involved in completing medical credentialing in the state of New Jersey:

  • Set Up Online Portals. Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Availity payers, set up those portals as well.
  • Primary Source Verification. Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. Payers in New Jersey have specific requirements.
  • Work History and Reference Checks. To assess the provider’s experience and reputation within the healthcare community, the work history of the provider must be verified without any gaps longer than 30 days. 
  • Background Checks. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. 
  • Payer Enrollment. Providers must be enrolled with every payer they accept insurance from — again, before they start seeing patients. With an average of 5 – 10 payers per provider, this can be a time-consuming and tedious step that needs to start early in the credentialing process. 
  • Privileging. Privileging involves the collection and review of a provider’s documentation to determine if they’re worthy to provide care to patients within a specific institution. All providers must receive privileges at the facility where they will see patients before they begin practicing. 

Tips To Speed Up Credentialing in New Jersey

The time it takes to credential providers in New Jersey can vary depending on a variety of factors. Generally speaking, federally-qualified health centers (FQHCs) and community health centers (CHCs) will take about a month and all other payers are likely to be at least 60 days. The exact timeline depends heavily on the provider’s specialty, volume of providers, and the efficiency and completeness of the provider’s documentation.

1. Start as soon as the provider is hired.

Make sure you start collecting documents as soon the provider is hired and encourage the provider to set up any online portals. Credentialing early will also alert you to any red flags or complications early in the hiring and onboarding process. 

2. Make it easy for providers to submit documents.

It is much easier for you and the provider, to request digital documents as opposed to collecting a paper credentialing packet. Credentialing software offers the ability for providers to securely submit documents to an online portal. 

3. Set a process specific to New Jersey’s payers.

Payers, such as Horizon NJ Health, all have specific requirements for the state in which they are located. Understanding this process and creating checklists for each payer will help you to complete medical credentialing in New Jersey much more quickly. A process (workflow) ensures continuity in case the credentialing expert is out of the office or has moved on. 

4. Set reminders and notifications.

Scheduling reminders for follow-ups can help you shave hours or weeks off your credentialing process. There’s likely to be a lot of back-and-forth in verifying information, so be sure to schedule reminders every time there’s an additional step required to complete the action. Credentialing software can automate these reminders to ensure you don’t miss steps or deadlines.

View this guide for more tips on speeding up your credentialing process.

Keep Credentialing Organized for New Jersey Providers 

Using medical credentialing services in New Jersey can help to speed up the process because these credentialing specialists are used to the rules and regulations. In many cases they have also developed good working relationships with the payers, which can smooth the process. 

Find out how MedTrainer can help — whether you just need software or you’re looking for credentialing services to handle the process for you.