Insurance companies grant approval for your participation in their provider network through the process of credentialing. As a result, medical professionals receive compensation from insurance firms for rendering services to their insured clients.
Insurance companies need to ensure that you have the qualifications required, are within the medical field, and will be competent in providing the necessary services. Nevertheless, insurance companies have other credentialing requirements, including, in some instances, filling out detailed forms for medical practitioners with copies of medical licenses, board certifications, and proof of malpractice insurance and education, among other documents.
After this, the insurer attaches approval to you as an in-network provider.
Step-by-Step Guide to Getting Credentialed
Step 1: Gather the Required Documentation
When providers are ready to begin the credentialing process, the first step is having the required documents in hand. This will go a long way in making sure that the process is smooth.
Here’s a list of typical documents insurers will ask for:
- Medical License: Any given state medical license helps to ascertain that you are licensed to provide medical services within that particular state.
- Malpractice Insurance: Insurers will want to know that you have the appropriate malpractice coverage in case a claim arises.
- Board Certifications: It is also important to have board certifications in the area you intend to qualify.
- Curriculum Vitae (CV): The CV presents extensive details on a provider’s work history, educational attainments, and related qualifications.
- Proof of Education: Diplomas and transcripts may be requested to confirm your qualifications.
- Personal Identifiable Information: This includes your Social Security Number, Tax ID Number (TIN), and other personal details that are required for credentialing purposes.
Step 2: Complete the Credentialing Application
Before moving forward, after securing all necessary documents, approach the carriers of your choice to complete their application forms. Most of the carriers will have their own form-filling process; however, it usually includes submission of the gathered documents, interviews regarding professional life history, and details about the practice.
It is also worth mentioning that there are certain aspects, such as the language, the form, available information, etc., that will also help make the process easier, more comprehensive, and more effective. Insurance companies have a habit of attaching too much importance to such details, so be careful when completing this information.
Step 3: Submit the Application
On the submission of the application, send it to the insurance company. The process can be done via computer, through mail, or sometimes physical contact is made with the insurer. Some insurance companies also offer real-time tracking options for submitted applications, so you can track the overall progress of the application from your comfort.
Step 4: Wait for the Credentialing Review
When the forms are filled out and submitted, the insurance company will then look at the application and the presented documentation. This review can usually take between 30 and 120 days, depending on the insurer and the nature of the credentials that you attach. During this period, the insurer may request further information, and this creates a lot of time lag.
However, during the waiting time, it’s advisable to try calling or writing to the insurance company to check whether there is a problem with your application. It’s worth checking frequently if there is any additional documentation required.
Step 5: Approval and Contract Negotiation
Once the insurance company completes its review, you will receive a notification about the status of your application. If you are approved, the insurance company will send you a contract outlining the terms of your participation in their network, including payment rates, responsibilities, and other important details. Be sure to review this contract carefully and consult with an attorney if needed before signing.
Step 6: Keep Track of Expirations and Renewals
Credentialing is not an on-off activity; it is a constant procedure. Insurance companies normally require providers to re-credential every 2-3 years for confirmation of competency. You have to know when the particular credentials expire and when to apply for re-credentialing in order not to lose the ability to accept payments.
How Insurance Credentialing Services Can Help
Even though insurance credentialing is vital to your practice, the process can be frustrating when you are undertaking the process on your own. Well, that’s where insurance credentialing services come in handy, as we shall see later on. These services focus on credentialing from the initial stages to the final stage, helping you avoid numerous hassles all while keeping you on the right side of the law.
Here are some key benefits of using insurance credentialing services:
- Expert Knowledge and Experience: With extensive experience in dealing with insurance companies, credentialing services are proficient in understanding their specific requirements and deadlines. They help prevent errors and save time during the procedure.
- Time-Saving: The paperwork, follow-ups, and corrections required for the credentialing process can extend its length. Outsourcing that task will give you more hours to focus on your patients.
- Simplified Workflow: Credentialing services take care of all the work, starting from the collection of documents up to the submission of the applications and even chasing the insurance companies. What this means is that you do not have to worry about any steps or timelines you may be missing.
- Faster Processing: In-network credentialing services have extensive industry knowledge and relationships with insurance companies, enabling them to help you save time by facilitating your enrollment.
- Peace of Mind: With experts handling the tasks, you are assured of the appropriate and correct execution. This relieves stress and empowers you to do what you are trained to do—giving quality care to your clients and patients.
