Healthcare Insurance Credentialing Services for New Medical Practice

Every time a new practice opens for business, they find that securing acceptable insurance reimbursements takes much longer than expected. This is despite investing many hours and dollars into office space, furniture, technology, and staffing.

Most times, the issue could have been resolved by taking care of the insurance credentialing procedure fully and developing the required connections with insurance companies. Here are some things to think about as you approach the insurance credentialing procedure.

Timing: Get Going Early!

Plan to begin the insurance credentialing process well in advance; at the very least, give yourself six months before seeing your first patient. Even if everything is in order, carriers frequently take 3–4 months to study the documentation and make a decision.

Several more weeks or even months may be added to the procedure if there are mistakes, gaps in the information, or concerns with the material that has been provided. This six month window, beginning when credentials are submitted, usually provides adequate time to handle any issues that may come up.

You run the danger of being charged an “out of network” fee, having reimbursements forwarded to the patient, or, in the worst case situation, not being reimbursed at all if there is insufficient time allowed before the practice opens and you start seeing patients before insurance credentialing is through.

Determine the Target Carriers

Considering your practice location and patient demographics will help you determine which insurances you might be credentialed with.

Will a sizable portion have Medicaid or Medicare? Is there a certain firm or company in the area that employs a significant fraction of the locals? You may get a decent idea of the carriers you should take into consideration by giving their human resources department a quick call to find out what insurances they presently provide employees (as well as any changes that may be coming soon).

Check with coworkers, other healthcare professionals, local clinics, and even bigger hospitals to find out who their preferred payers are. Find out which payers are the finest to work with by asking about who pays promptly, who has the greatest enrollments, and which carriers might be fully booked with other specialists in your field.

Make a list of the top 10 or 15 insurance companies as you determine which may be the most well-known in the region. After considering what other service providers are saying, reduce that list to the top 7 or 8. This will be the short list of places you plan to visit next.

Avoid selecting too many right away since, if nothing else, you’ll exhaust yourself trying to keep up with the submissions.

Reach out to insurance providers

Prepare to spend at least an afternoon (or more) on the phone with the provider services departments of each of your target carriers once you have a list of 7 or 8.

Asking if they are accepting new practices in your speciality in your area can be one of your first questions. Most of the time there is no issue here, but if they say no, move on to the next person on the list and get ready to check back with them later to see if there is an opening.

Make sure you obtain all necessary information regarding the procedure, including names, addresses, phone numbers, timing, required forms, and so on, if the carrier is amenable to new providers. Remember to inquire about online submission as well, as many carriers now let you submit all of the required information online and mail the supporting papers.

Sending your Credentials

You’ll need to gather and submit all of your information once you’ve finished your research and decided which insurance companies to file with. Most will often demand that you give them the following:

revised resume
individual demographic data
Information on practises and businesses
Federal and state DEA numbers
information about state registration and licencing
Evidence of schooling, such as an ECFMG certificate or a diploma
Information on malpractice insurance
Information about potential sanctions

Even while this may seem like a lot, there is some good news: since the majority of carriers require the identical facts, once the first submission is finished, you can simply copy and paste the information from one form to the next. By keeping copies of these documents in a secure location, you will also gain a lot in the future. You will have access to the same repository of information when your practice develops and you want to become credentialed with different insurances.

Don’t forget to double check everything once you’ve finished the application. In fact, double and even triple check it, and ask someone else to do the same.

Expecting carriers to fix a clear error on your behalf is unrealistic because they are not responsible for doing so and, quite simply, they won’t. It is imperative to review everything several times because even the smallest error might delay the procedure by a month or longer.

Finally, after submitting your information, give yourself enough time (1-2 weeks for mailed submissions) and check in with the provider services office to make sure it was received. Call the person personally if you were able to find their name during your preliminary research.

If the receipt has been confirmed, don’t be afraid to check in again in, say, 3–4 weeks to see if they have evaluated it yet or if they have discovered any issues.

If everything goes according to plan, expect to wait another 3–4 weeks before making another check. If you can find out over the phone that there was some sort of hold up, it can greatly reduce turnaround time.

As previously mentioned, anticipate this phase of the process to take many months since credentialing offices are frequently centralized and may be examining hundreds of applications for numerous fields simultaneously.

With your initial selection of 7 or 8 carriers, perhaps your diligence and persistence paid off and you were successful in passing the insurance healthcare credentialing services offering in a relatively short period of time. Consider going back to your longer list of 10-15 and starting the process all over with the remaining carriers if you’re up for the task yet again.

Several short cuts

Engage qualified assistance:

The process of obtaining insurance credentials can be aided by a wide variety of organizations. In many cases, this step is already covered if you have a contract with a practice management business.

If you’re thinking about connecting with outsourced billing services to handle your insurance and patient billing, they should definitely have the carrier experience to at the very least offer you some advice, if not manage the process entirely.

Additionally, a few professional insurance credentialing firms that specialize in this procedure for new practices exist, however they are frequently very expensive.

Summary

A speedy transition to profitability and a strong start for your practice depend on the insurance credentialing process. Even while it can take time, getting started early can provide you time to fix issues as they come up. You’ll succeed if you’re patient and remember this advice: