Credentialing Tid Bits
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Credentialing Tid Bits

Have you considered joining insurance panels, or becoming contracted with insurance carriers so that you can see patients that carry a specific type of insurance?  Do you know what it will take to do so?  Which carriers do you choose to work with?  All of these are important things to consider when you are wanting to become contracted with any insurance carrier.  First, you need to think about the which carriers you are interested in joining (Aetna, BCBS, Cigna, Humana, Medicare, Medicaid, united Healthcare, Tricare).  Second, you must consider the process you have to go through to become an in-network provider, the credentialing process.  This process requires you to; (1) complete either an initial Letter of Intent or application request, (2) complete an extensive, detailed application, (3) complete the CAQH online database, (4) sign and agree to the terms/agreement and reimbursement schedule set forth by the insurance carrier.  You can also anticipate your agreement will be renegotiated every couple of years.  So what are common reasons providers get denied to join a network:

  • Incomplete application
  • Not allowing any more providers in your area of specialty into the network within your geographical area (city, town or county)
  • Not licensed or registered within the field of expertise that they will contract with
  • Not contracting with your provider type

So how do you deal with these types of issues? Always make sure you have completely filled out your application, leaving NOTHING BLANK.  Or you can always ask for assistance from a company that works with providers through the credentialing process (such as Rill Unique Enterprises).  Make sure that you designate yourself within a unique specialty in your area of practice.  Double check to see what type of licensing the carrier will accept or if you must be just registered and licensed.  If they don't contract with your provider type, do you have other options?  If so, what are they? Always make sure to include all additional documentation they request, such as; W-9, proof of liability insurance, and licensing/registration certificates to name a few.  The credentialing process can seem 'scary', but if done correctly, the payoff of accepting patients with insurance can be very beneficial to your bottom line. 

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