Like every one another blog, to get started with, it has to talk about your pain points. There are pain points which every practice administrator faces, and they always wish that these could have been solved earlier. Through this, they expect that the situation could have been better and improved.
There are a few points that they could have known it earlier which in turn, would make their struggle with insurance way more easier than now it appears to be.
As the administrator of your practice, when you think of the insurance, there comes the concept of enrolling your physician and your practice into an insurance panel. The enrollment process is nothing but applying you to become their participating provider into their network panel. It has two steps down the process: One is Credentialing and the other is Contracting.
In credentialing, it involves the verification of your credentials and its supporting documentation. Here the specialist at their network panel will confirm whether your credentials are obliging with the provisions and standards of the insurance panel or not. Once it is approved, they will send a contractual agreement to the physician. In this case, the physician should agree with the standard fee schedule or the reimbursement rates that suit them. In some cases, you can also negotiate these terms with the insurance and try demand for reimbursement rates which is better than the standard rates. When everything gets settled, your signed agreement will be sent back to the network panel. After a waiting period, you will be given the effective date along with insurance provider id. Credentialing and Provider enrollment are often colloquially used by everyone.
Let’s look at some of the few quick notes which may benefit every administrator at the practice who plans to recruit another physician and do his insurance credentialing.
Start with Credentials
You should always start with verifying provider information such as their Education and Employment history, Professional ids like their Board Certification Number, TAX ID, Taxonomy, their Medical license to practice in the state and NPI. And other federal registrations such as DEA and CDS. Any professional training like Internship, Residency, and Fellowship. Also, note about other Credentials to be noted such as their Practice location, Mailing Address, Professional Liability insurance for the physician and their practice and if needed, verify using some professional references as well.
Understanding the Regulations
Every state may have their own laws and so does the Insurances. Some insurances do have their own clauses in recruiting a physician in their network. Some insurance may have terms and conditions that they need only fewer physicians under their network. This will hurt every new physician’s pocket who is trying to get into their network.
CAQH and Commercial Insurances
A well crafted CAQH profile would always be a PLUS while, enrolling physician's in an insurance network. It is a more adopted program by today's commercial payers. Every provider's credentials information shall be maintained and shared with affliated payers on demand.
A Prodigal Application
In order to begin with, We have to make sure the application surpasses the process for the first time after we receive all the credentials above. There should not be any repetitions in acquiring the information from the provider; this is because this may lead to more chances of working on it all over again.
The Right Person for the Job
It is essential to employ a Credentialing specialist or a Coordinator. They should manage the process and make sure that everything is going with ease. Either in-house employee or out of the office , this helps the process to be monitored, communicated, followed-up on and ensuring everything reaches its final goal by setting appropriate reminders.
As, it is a time-consuming process and for enrolling a single physician in insurance, recruiting a coordinator in-house will not be a better idea and will impact heavily on your budget on a long run. Because employing someone in-house specifically for the job demands a hourly pay, taxes, employee benefits, 401K, paid leaves that are included as the benefits of the job description.
But, when you have employed an outside company, the perks that come with it is, that you get to utilize them on the need of the hour basis for credentialing. Whereas here, you can rely on a team of people focusing on a specific task, with uninterrupted follow-ups and monitoring along with checking its status is way more efficient. The workflow will always be streamlined; and the physician always knows where his enrollment stands.