How to Get Credentialed for Insurance Coverage
When starting a private practice, one of the first things you’ll need to do is start getting connected with insurance companies so that you can deliver care to your patients accordingly. There are dozens of different insurance companies out there and they all have their own application and credentialing process, but the standard procedures are the same. If you are not familiar with the process, you will need to educate yourself so that you can get your practice set up properly.
The good news is that there are a lot of tools and resources to help you get your practice set up with all the right insurance providers so that you can deliver the care that your patients need with coverage that works for them. There are even digital practice management tools that can help with credentialing, insurance applications, and the rest of the billing process so that your practice runs more efficiently.
What Is Credentialing?
Doctors will find that insurance companies want to verify their professional experience, education, and training to ensure that they meet the insurer’s requirements for provider coverage. The entire process takes around 90-120 days, or three to four months. This depends on the application process and the insurance companies, including how fast they process applications for new providers or those who are reapplying with updated credentials.
The basic steps are as follows:
- Obtain and prepare your information
- Join the insurance network
- Complete the application
- Submit the application and obtain a reference number
- Complete contracting agreements
- Set fee schedules
- Execute contract
- Verify participation and credentialing
What Information Will I Need?
There is a wealth of information that will be requested from insurance companies when you are trying to get credentialed. You will need to have your NPI number, or National Provider Identifier number as well as your CAQH ID, with a valid W9 and malpractice certificate that shows that you have coverage. If the insurer requires additional information, they will advise it as part of the application process.
Once you have the information ready, you can select to “join network” for any insurance provider that you want to partner with in your private practice. If there isn’t a button or link readily available on their website, you might want to contact the payer to find out how to go about getting set up to take their insurance. The good news is that most companies today have hotlines to assist with credentialing and getting set up for insurance coverage.
Contracting and Fee Schedules
Once the application has been approved, contracts will be issued and fee schedules will be set. The contract agreement will be drafted by the insurance provider after a conversation with you or your practice manager. They will set the fees, which take about 45 days to build and process. This will determine what your costs are related to the insurance coverage offered, including copayments and other fees and charges.
The contracting process can take time because it can go back and forth between the provider and the insurer until all the details are hammered out and in agreement. In some instances, contracts may not have any leeway or fees might be set in stone—in that case, you have to pay what you have to pay. Make sure that you request a fee schedule if you’re not given one so that you know what to tell patients concerning their coverage.
Best Practices and Tips
As a provider, you have a lot on your plate. Getting credentialed is another task that can be time-consuming and tedious because of the information gathering required. Fortunately, if you are prepared, it can be easier to streamline the process and get quicker results.
First and foremost, make sure that you have proper malpractice insurance, register with Medicare/Medicaid, and know how you are going to be billing for your services. You will also need to get your NPI (National Provider Identifier) number, which will either be individual or organizational (type 1 or 2, respectively).
Feel free to check in with the insurer throughout the process to make sure things are on track and that they’re not missing anything. It’s not uncommon for insurance companies to get sidetracked or be missing paperwork and simply move on to the next task, forgetting to notify a provider or request more information before setting the file aside. Don’t bug them too often, but if they seem to be dragging their feet, it’s okay to ask what the hold up is. The review process can take some time, but there’s no reason it has to drag out longer than necessary.
If you don’t know your NPI number or any other details, make sure that you gather those before you get started. You can often ask the insurer for assistance in getting the materials and information that you need together, too, but if you can do it before you contact them, you’ll be better prepared to dive right in. Once everything is verified and set up, you can double-check your billing system and make sure that everything is in place so that you can start accepting claims.
How Can ClinicMind Software Help?
In addition to providing a comprehensive solution for practice management, ClinicMind also offers credentialing services, in addition to consults and billing services. The platform can assist with everything from billing and scheduling to charting, providing fee schedules, and other business-related aspects of running your private practice. This will allow you to spend less time on financial issues and more time taking care of your patients, which is why you got into private practice in the first place. For a total EHR/RCM solution that covers all aspects of practice management, ClinicMind has you covered.
Conclusion
Credentialing is an important part of the insurance process for your private practice. However, that doesn’t mean that it’s something that should take up a lot of your time. In fact, with the assistance of ClinicMind software, you can ensure streamlined applications for approval with your insurance providers and easy credentialing, allowing you to return your focus to your patients.
