Credentialing with insurance companies is an integral component of healthcare practices/organizationss; however, credentialing can be time consuming and complicated. This article provides a clear path for managing this process successfully.
Expecting that this process will be as straightforward as filling out an application is an unrealistic assumption; expect at least 10 hours of focused work for every company you wish to join the panel of.
Choose the Right Companies
Credentialing is one of the most crucial steps a new private practice provider must take in order to become In-Network with insurance companies and therefore reimburse patients when submitting claims for treatment. Unfortunately, credentialing can be an intimidating and time-consuming process with numerous moving parts that need to be managed for providers to get listed on an insurer’s panel – calendars, file management tools and backup solutions may help smoothen out this process for successful providers.
First step of credentialing with insurance providers should be selecting which companies to work with. Research may help providers choose appropriate local plans; once this decision has been made, providers can then begin gathering all required documentation and submitting it directly to each insurance carrier.
Once the insurance company has verified your information submitted, they will proceed with the contracting phase. In this phase, they will negotiate with providers to establish an In-Network relationship and draft an agreement that details services that the provider will offer, how much will be paid per procedure, as well as reimbursement structures.
Once a contract is in place, credentialing should come to an end and patients can begin seeing providers. It’s important to remember that contracts will need to be renewed regularly – it is best to stay in close communication with insurance providers so you are informed when it is time to re-credentialize as soon as they notify.
One major mistake many providers make is missing their re-credentialing deadline with insurance companies, which can be extremely costly in terms of time and resources spent starting over again. One clinic found themselves losing $100,000 per month because of an administrative mix up resulting from missing their deadline with Blue Cross Blue Shield; fortunately they hired a credentialing service which helped get back onto panels and resume receiving payments again.
Gather the Required Documentation
Insurance credentialing is an essential step in healthcare provider and facility operations, enabling them to join networks offered by insurance providers, thus allowing their patients accessing treatment without incurring out-of-pocket expenses or meeting deductibles. Unfortunately, this process can take time; thus it’s essential that healthcare providers and facilities devote enough effort and focus towards gathering all required documentation prior to beginning this step.
Collect all necessary documents, such as primary source verification documents, malpractice insurance documentation, DEA and NPI numbers, practice address and phone number, state and federal registrations, W9s etc. It’s best to send this information in one cohesive package instead of sending individual pieces – this way it won’t become misplaced or attached to the wrong file!
As part of your application phase, make sure all required information is filled in accurately and thoroughly. Any discrepancies could delay or deny credentialing altogether. Be ready to provide additional information or supporting documents if requested; don’t become disheartened if your credentialing application is denied – there may still be time for reconsideration; be thorough and persistent with the insurance panel during this process.
Once the insurance company approves your credentials, the contracting phase will follow. Here, the insurer and your practice will come together to agree upon a set of terms determining how much will be reimbursed for each service provided and for how long. This step is invaluable as it helps plan for and budget for future needs of business operations.
In order to expedite this process, consider teaming up with an organization specializing in insurance credentialing like Headway Medical Billing that has access to networks, relationships, and processes that will quickly place you into network with insurance companies. Also remember to keep accurate credentialing records while keeping current on any renewals or updates required – failing to do so could delay or deny services from an insurance provider.
Submit Your Application
Documents necessary for insurance credentialing include an inventory of services offered, state and federal registrations, malpractice insurance policies, National Provider Identifier (NPI), tax ID numbers, practice addresses and office hours if applicable. Any documents due for renewal should be done so well ahead of your application date so as not to cause issues during data validation processes with insurance providers.
Medical credentialing can be a tedious and stressful process that many providers dread. Applications often become lost in translation or rejected altogether; to keep in touch with each insurance company you work with and assess their status of applications every couple weeks and respond swiftly if any issues arise.
Once credentialed with an insurance provider, you should receive a contract outlining which services will be covered and what portion of your fee they will reimburse. It’s extremely important that this step be completed on time as missing it could mean losing in-network status and needing to bill patients out-of-network instead. Email reminders may come your way prior to your re-credentialing date so be sure to set aside enough time for processing all paperwork needed for re-credentialing.
One of the main mistakes practices make when seeking accreditation is failing to submit their paperwork on time and keeping track of it all. Medicare credentialing processes can take several months to complete and submit, creating additional delays for processing credentials. Create a folder on your computer dedicated to credentialing paperwork, and ensure you have everything organized if there are any delays with credentialing applications. Regularly review your CAQH profile to make sure the information there is current so insurance companies can quickly verify your credentials, saving time and stress in the process. Using professional credentialing services may speed up this task considerably while decreasing its burden.
Follow Up
Insurance follow up is an invaluable way of making sure your health insurance coverage is providing what it should. Your aim should be to obtain coverage at an equitable price; insurance follow up can take the form of phone calls, emails or personal visits and should always be conducted politely but assertively; if customer service representatives refuse to fulfill their responsibilities for whatever reason then seek legal advice as necessary.
As part of their startup activities, healthcare practices should obtain insurance company credentials quickly and easily in order to gain reimbursement and access patients. Although credentialing with insurance providers is important, the process itself can be lengthy and cumbersome.
This blog post’s goal is to assist the reader in understanding how to navigate the credentialing process, with tips to make it faster and simpler. Furthermore, this post will discuss ways that healthcare practices can ensure their information submitted is up-to-date and accurate; additionally it is important to remember that credentialing should be renewed periodically to stay compliant.
Insurance credentialing is a process for verifying that healthcare practitioners meet certain standards, making them qualified to offer services to their patients. Furthermore, credentialing lays the groundwork for contracting stage in which insurance company contracts with healthcare practice to become in-network and sets out specific terms of partnership agreement.
Credentialing must be renewed regularly, and healthcare practices must ensure they stay current on this process. Failure to do so could result in the loss of an insurance partnership that could cause substantial financial strain for both themselves and their patients. Using tools like calendars, file organization systems and backups to stay on top of credentialing should help healthcare practices remain compliant.