Credentialing for Ambulatory Surgery Centers

Ambulatory surgery center credentialing operates on two parallel tracks that must be carefully coordinated: facility credentialing and physician credentialing. A surgeon who is fully credentialed as an individual physician cannot bill ASC facility fees until the surgery center itself is enrolled with each payer. Conversely, an enrolled ASC facility cannot bill until the operating surgeons are credentialed under the facility's agreements. For Medicare, ASC certification is the foundational requirement. CMS must certify the ASC as a Medicare-participating facility before any Medicare billing can occur. This certification process involves a state survey and may take 90-180 days from application. Once certified, the ASC receives a facility NPI and can begin enrollment with other payers. We coordinate the CMS certification process and manage subsequent payer enrollment so both tracks progress simultaneously. Commercial payer contracting for ASCs involves facility fee schedules that are negotiated separately from physician fee schedules. This means an ASC may have different in-network status than the physicians who operate there from certain payers' perspectives. Patients and referral sources find this confusing, and it creates billing complexity. We manage both the facility and physician enrollment tracks to maximize in-network alignment. For multi-specialty ASCs performing procedures across orthopedics, ophthalmology, gastroenterology, pain management, and other disciplines, credentialing complexity scales with each specialty added. Each new specialty brings new surgeon credentialing requirements, potential facility privilege updates, and possibly new payer agreements for specialty-specific procedure codes. Arctic Health's ASC credentialing practice combines facility enrollment expertise with physician credentialing to give ASCs a single point of coordination for the entire enrollment process.