Maximize your impact—and get paid for patient care

An introduction to pharmacist credentialing and health plan enrollment

Pharmacists are playing a bigger role in patient care than ever before, but it can be challenging to get enrolled with health plan provider networks. This short video explains how you can take the next step in your career by becoming a credentialed healthcare provider. Learn about the process, the benefits, and how to ensure you’re positioned to be paid for the care you provide. Watch now to take control of your professional future!

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Pharmacists

Pharmacists working in the pharmacy must enroll with the health plan as a health care provider.

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Step 1

Identify

For health plans with patients in your market, go to health plan’s health care provider enrollment website.

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Step 2

Application

Individual pharmacists submit an application to the health plan or insurer network they want to enroll with.

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Step 3

Verification

The health plan reviews the application and may cross-reference it with credentialing data to make sure the provider meets their requirement.

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Step 4

Approval

The health plan’s credentialing committee reviews the pharmacist’s credentials and approves them if they meet their requirements.

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Step 5

Contracting

Health plans rarely contract with individual pharmacy practitioners. Contracting is usually with the pharmacy a pharmacist practices.

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Step 6

Documentation

Capture the patient encounter.

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Step 7

Billing

Find a medical billing company.

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Step 8

Receivables Management

Billing and payment reconciliation. Payment terms will be driven by contract, but may be up to 90 days.

Three ways a pharmacist enrolls with health plans

  1. Individual Application: Health plan is responsible
  2. Network with Delegated Credentialing Authority: Network is responsible
  3. Hybrid: Health plan is responsible by outsourcing to a certified CVO

How network services work

  1. Health plans prefer to contract at a network level
  2. Documentation and billing will be driven by health plan policy
  3. Receivables are not in real-time
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