A complete guide to medical credentialing services

Credentialing is the method of confirming a carrier’s credentials to make sure that they are eligible to give treatment to patients. The majority of health insurance providers, including CMS/Medicare, Medicaid, and Commercial programs, as well as hospitals and surgery centers, require this procedure. It is a procedure of getting in-network with different insurance providers.

Medical credentialing services are a common term amongst medical practitioners these times, particularly among therapists, physiotherapists, and even massage therapists who could only operate “cash only” practice some few years back. Currently, however, such providers are discovering that many patients and clients expect them to consider their insurance as payment. if they don’t, they seek another practitioner that does accept the insurance as their payment.

As a result, when you’re not credentialed with major insurance firms, you are effectively turning away clients and the benefit they will offer you.

Getting credentialed (either on insurance boards) entails collecting and sorting out a series of insurance company applications (which may require up to 10 hours per panel), sending the applications to insurance firms, ensuring that each has accepted the application, and then doing a lot of follow up to monitor the progress from each application.

Although there appear to be just a few steps that seem easy enough to complete, health professionals often characterize the application process as “terrifying,” since it sometimes goes smoothly. You may want to keep track of the process by using the free tool soda pdf to create a PDF to keep on your computer or device.

There are a few things to keep in mind to make the process go more smoothly:

Form a list

Research thoroughly all the insurance providers, form a list, and find the company you want to be credentialed with. Different companies comprise different requirements and procedures that you have to go through.

Council for Affordable Quality Healthcare

The Council for Affordable Quality Healthcare, or CAQH, is most often required following an insurance company’s application to accomplish medical credentialing services (i.e., to get on insurance panels). CAQH is used by major insurance providers such as BCBS and Aetna as part of their application process.

There are some aspects you should be aware of about your CAQH application.

  • You need to be invited. You can’t just go to CAQH and fill out a form; you must be sponsored by an insurance provider. Firstly, you have to apply to the company, then wait for two weeks to assure that your application has been received and your CAQH number has been generated. After receiving the number your application will be sent to the insurance company who will complete it.
  • Your resume should be perfect: make sure your resume is up to date, with perfect dates of employment and education in its format. If the data is not properly mentioned then there are the chances of the rejection of your application. They won’t further send it to the insurance companies.
  • Filling out your CAQH on paper is never a good idea. Medical practitioners can complete an application online or on paper, according to CAQH. Selecting the paper choice is not a good idea. For starters, the application is 50 pages in length and can only be printed in color. However, once you send a paper application to CAQH, they will have to employ a data entry individual to process all of your details. If you call to inquire about your paper application, they advise you to submit your CAQH application online.
  • Reattest: Ensure that the provider performs a “re-attest” every 4 months. Re-attesting is a fast and easy way to ensure that anything in the service provider profile is still correct. When providers don’t re-attest, insurance firms do not have access to their profile records, which can cause credentialing delays.

Spare 10 hours for each insurance company

If you expect to fill your application in just a few minutes, you can do something wrong out of frustration. To avoid any blunder, expect at least 10 hours for each company you want to be credentialed with.  During this time, you’ll be gathering forms, filling them out, arranging required paperwork, and calling insurance companies to follow up. Although some applications are available in digital format, a large percentage must be printed and done manually.

You should call the insurance company for follow up in a week or two

Many insurance companies lose the application or get stuck in the limbo where they are mostly expired. The medical credentialing service process goes nowhere if the application is not reviewed properly for weeks and automatically gets rejected. In that case, you will have to start your application from the first step again.

Hence, you should call the company after every one or two weeks to check up on the status of your credentialing applications and to avoid any mishap.

Seek medical credentialing help

Using a reliable provider to assist through medical credentialing makes more sense for several medical practitioners. Using a credentialing program relieves not just the process’s stress and headache, but also saves time. Singing a program will also save money, and reliable service is more likely to get you credentialed quickly, allowing you to start treating insurance clients earlier rather than later.

Information that is required for Medical credentialing service

The required information and certificates may vary amongst the providers but usually the process is similar. During the procedure, the health care provider submits basic information regarding social security, degrees, graduation dates etc. However, to be precise, here is the list for some of the information that is required for medical credentialing services.

  • The license of practice and verification.
  • History of your work.
  • Degrees
  • Certification
  • Insurance information.

From beginning to end, the credentialing process generally takes 90-120 days. As a result, if you’re planning to open a private practice, don’t put off going through the process until the week before you start your business! ‘

There is no way, that makes getting on insurance panels is a simple task, however with the right training, resources, and perseverance, you could get credentialed. Make it a New Year’s resolution to get credentialed, particularly with the upcoming changes in health reform in 2013 and 2014.