Whenever a hospital facility or a practice hires a doctor, nurse, or healthcare physician, they need to verify the background, experience, and history of the doctor to get them approved by the insurance companies that the facility works with.
Whether a doctor has been credentialed in the past while working under another employer, they have to go through a credentialing process when they are hired. If you’re hiring a doctor for your practice and want to know how to credential a doctor with insurance companies, then the following information will help you find the exact answer to your queries.
How to credential a doctor with insurance companies?
Insurance credentialing is also referred to as healthcare credentialing where a healthcare organization monitors the qualification and skills required for the provision of healthcare in the facility.
In addition, facilities have to follow the credentialing guidelines provided by the Centers for Medicaid and Medicare Services – CMS. These guidelines oblige healthcare facilities to credential a provider in order to get eligible for the approved provider’s list so they can claim for the services provided.
No matter even if patients are paying out-of-pocket and are not insured, credentialing is important for those who are covered under CMS and third-party insurance providers.
Credentialing process varies according to the field of healthcare provider. The process of credentialing can be unique for some physicians as well. Although the process is essential, providers credentialing is crucial for;
- Health agencies
- Healthcare facilities
- Licensed massage therapists
- Physical therapists
For accepting Medicare and Medicaid reimbursements, healthcare facilities and hospitals must ensure that they meet the federal guidelines shared by the agencies including;
- The Joint Commission on Accreditation of Healthcare Organizations
- Centers for Medicare & Medicaid Services (CMS)
Other than these credentialing services from federal agencies, states also have their own specific requirements for credentialing a provider. By following them, they can help eliminate the liability that may arrive in a malpractice claim.
Important techniques for how to credential a doctor with insurance companies
1- Evaluate the required records
When provider credentialing is required, keep in mind that different insurance companies will have different needs and different documents required. Every insurer must provide complete information to the facilities whom they want to work with. Similarly, healthcare organizations must fulfill all the required documents as a single missing document or record can create snafus for weeks and months.
The best practice to gather all the required information is to list down all the required fields in a form or software that is needed by insurers. The information includes – but is not limited to;
- Proof of license
- Social security number
- Demographic information
- Residency and Educational information
- Career history
- Claim history
- Proof of insurance
- Patient-focused specialties
- Information about healthcare facilities worked before
Much of the information a provider would have in the provided application and resume. But for a level of accuracy providers would need to resubmit them.
2- List and prioritize insurers
Because patients are covered by multiple insurers, there will be multiple insurers that you want to work with. With this, you’ll need to submit multiple applications as a healthcare provider or healthcare organization. For this reason, it will be beneficial for you to prioritize what dossiers are there that you need to submit first;
- See what insurance provider has a significant portion of your claims. Priorities their applications and documents submission first.
- Stay informed about the regulations of the insurers and third-party insurance providers. Many times, insurances approve providers that are already approved members of other insurers in different states. This would lead to quicker approval.
- Oftentimes, insurers provide an abbreviated application for physicians credentialed in other states/insurers.
Adhering to these points, make a list of documents required for each insurer and submit your applications accordingly.
3- Verify the provided information
No wonder the credentialing process takes time. When you begin with assembling documents, bear in mind that the accuracy of the information is everything that you would need.
Before you turn up to the insurer with the dossiers and applications, make sure to go through the following to verify them;
- Perform a background check
- Review history of privileges, credentialing, and malpractice claims (if any)
- Verify licensing, educational documents, board certification, training, and reputation through organizations like The Educational Commission for Foreign Medical Graduates Certification (ECFMG), The American Medical Association (AMA), and The American Board of Medical Specialties
- Also, check the list of sanctions recorded with OIG – Office of Inspector General.
If the insurance provider finds any error in the provided documents and submitted applications, it may cause issues, such as;
- Incorrect information can delay the approval process
- Incorrect or misleading phone numbers or information can create rejections
- Not mentioning malpractice claims will result in disqualifying
4- Wait for verification
Once you have done your part of the process, it’s time to wait for the approvals from the insurance side. Again, verification and checking a whole lot of information and documents to approve a provider for claims is a lengthy process. According to an average, credentialing completes in 90 days. But industry experts say to expect it to take 150 days. Also, if serious credentialing errors come up, it may take even longer to complete or reject the application.
5- Keep following up
Once you submit applications and documents, don’t wait to hear you’re your insurers. Healthcare professionals in credentialing services advise taking continuous follow-ups to get timely approvals.
Once your applications are approved, your providers will get reimbursed from the listed insurers. However, credentialing just does not stop here, as it is an ongoing process. If not all of your applications are approved, you must ensure to update information and go through all the steps again to resubmit them.
Working with insurance companies and getting doctors to be credentialed is a lengthy process. This is why healthcare organizations hire medical credentialing services to ease the burden and focus more on the patient’s healthcare.
Credentialing services are more aware of the updated guidelines from the insurers either federal or third-party and have the required skills that will expedite the credentialing process for healthcare organizations. To cut the paperwork and your time, hire one that will help you increase your productivity in the field.