What is Medical Credentialing?
For many licensed medical professionals, Medical Credentialing is known as
1) “the process of becoming contracted with insurance companies”, or
2) “the process of getting on insurance panels”, or
3) “what you need to do to be able to accept insurance.”
If the process of credentialing is done carelessly, or passively then a few important details could be missed about the particular physician in question. When the process of credentialing is skipped, then it could spell doom for your practice by causing cash flow issues, scheduling hurdles and in extreme cases, putting the well-being of patients at risk.
How do I Become Paneled with Insurance Companies?
The idea behind medical credentialing is simple. You (the medical provider) choose which insurance companies, EAP, or the government programs (Medicare, Medicaid) you want to work with. You apply to be a “networked provider.” You get approved and begin seeing patients.
Ok, Medical Credentialing isn’t quite as easy or simple as it sounds. The process gets a bit more complicated when you take a closer look.
Either way, the point is no medical practice wants to have issues with credentialing in order to avoid trouble in the future.
So what are some ways that can help reduce problems when it comes to credentialing?
Medical Credentialing Steps:
1) Decide what insurance companies you want to be a provider for.
If you’re not sure what insurance companies you want to work with, start with the major ones: Blue Cross / Blue Shield, Aetna, Cigna, United Healthcare, Tri-Care, Medicare. A good way to identify what plans are popular is to ask some friends and colleagues what insurance they have personally. Alternatively, you could call a medical practice in your area and just ask them what insurance companies they serve they’ll probably tell you.
2) Contact insurance companies to request a provider application.
This can be harder than it sounds. Expect to spend about 30 minutes on hold, only to then be told to call another number, or get someone’s voicemail, or (about 20 percent of the time) find that no one is available and there’s no option to leave a message
3) Complete and submit the provider application.
Once you receive the application, complete it fully, make a copy and then send it back.
4) Stay up to Date with CAQH
CAQH is an abbreviation for The Coalition of Affordable Quality Healthcare who began their uniform credentialing 15 years ago. Since their program kicked off, it has attracted admirers from all over the country with most medical practices picking it up. Physicians who stay up to date with CAQH find the credentialing process much easier than those who do not.
5) Linking a Physician’s Start Date
It would be great for the practice if the new physician’s schedule can be filled soon enough. Linking a physician’s paperwork submission dates to their contract is therefore very important.
6) Complying with State Regulations
Different states have different legislation that governs medical credentialing services. Therefore, it is important to get in touch with your state medical group association or your medical society in order to ensure that you are practicing within your state’s standard. You also want to observe interstate reciprocity regulations such as a partial credentialing process for physicians changing practices within the same state.
Contact us for more information for more customized credentialing options suitable for your practice needs or to read more about Provider Credentialing visit our article.
