For medical and healthcare providers, credentialing is one of the popular terms used. It is the term for initiating a network and getting on to insurance panels.
Medical credentialing has become a main focus of providers these days essentially among chiropractors, counselors, and massage therapists evenly. This is because they were among those who only received cash for their services just a few years ago. If you’re one of them, you might be wondering how to become a provider for insurance companies.
What is the insurance credentialing application process?
Insurance credentialing requires a whole lot of documentation, filling and submitting a never-ending series of applications where one application approximately takes ten hours to complete for one insurance panel. However, the story doesn’t end here. Once the application is submitted to every insurance provider, you have to make sure that they have received the application, and then it involves continuous follow-ups for tracking your application progress on each panel.
While they may seem to be a few steps that can be completed in no time. However, providers went through the process and often described it as a ‘nightmare’. Because the application process progresses to approval rarely and many practitioners find themselves dealing with rejections, re-enrolling themselves into panels, resubmitting applications, and chasing the process until insurance companies approve them as credentialed partners.
Not only does the process take a toll, but oftentimes, when you apply for credentialing at an insurance company, they reject the application saying that they are not open to your type of field or they already have too many providers for the same field.
Looking at these hardships, it doesn’t remain a secret that medical credentialing is something that providers do not look forward to but have to go through the process to not lose clients and great opportunities which come along with the business of credentialing.
It may sound daunting to continue with the process of credentialing, but knowing the right process and some tips and tricks will help you make the credentialing process smooth and easier to get along with.
How to become a provider for insurance companies?
1. Make a list of insurance companies
Carry out an in-depth research process and make a list of insurance companies that you want to be credentialed in as an insurance provider according to your field and get the required information for applying. Each insurance company may have different requirements and processes for applications. Ensure to acquire all the varying information that you would be hoping for in the next phase.
2. Complete CAQH and be prepared for other requirements
Council for Affordable Quality Healthcare – CAQH, is required when you are submitting a credentialing application for the insurance panel. Most insurance companies including Aetna and BCBS require CAQH as a significant part of the application process of credentialing.
Tips to consider while applying for CAQH
- It is not any usual platform where you log in and upload your information. To apply for CAQH, you must have an invitation prior from an insurance company. This is something mandatory. Therefore, first, you need to apply to an insurance company and keep following up if they have approved your application and generated a number for CAQH.
Then, to complete the application process, you go to CAQH and return your application to the insurance company to complete the application process.
- Fill out your CAQH online
CAQH provides two options to the providers to fill out their CAQH forms. They can do either the online option to fill out the form also for in paper filing. However, the providers are suggested to fill them out online as the application consists of 50 pages and can only be viewed correctly if it is taken out on colored print. Secondly, when someone submits a paper application to CAQH, they need to hire a data entry person to transfer all the data into the online software which may delay your application process.
Plus, you cannot rely on the data entry person to input your data correctly into the platform and do it as it is provided. According to providers, CAQH data entry does not enter all the data and the process never reaches its end. Therefore, it is better to save time and do the proper online submission to get things done at hand.
- Make a perfect resume containing the required information
To cut the mustard in your application process is to ensure that your resume is up to the mark. Your dates and year of employment and education must be mentioned along with their details in the format of Month/Year. If any date or year was missing from your resume, they will not send your application to insurance companies. The second most important thing that you need to make sure of is the gaps between the employment. Trust the process, if there’ll be even a single day of the gap between your employment history, they’ll ask and verify it. Therefore, to save your neck from getting into hassles, ensure that your resume is crafted according to your needs.
- Get re-attestation when required
You’ll need to re-attest your CAQH application every four months in a year. You’ll be asked by your insurance provider about the re-attestation as they are informed about the CAQH process. This doesn’t take long, you just need to log in with your credentials and get it within a few clicks online.
3. Devoting 10 hours to every insurance company you applied
After going through a not-so-smooth credentialing application filing, on approval, you need to serve 10 hours of intensive labor with every insurance company that you wish to work with. However, these ten hours include filing and retrieving applications, organizing records and documentation, and following up with the companies over phone calls or in person. Although many times the applications are online, the majority of companies need them to be printed and filled by hand.
4. Keep following up with the insurance companies
Say it is a workload or a usual workstation routine, insurance companies have a high rate of losing applications or putting them somewhere that they are not properly being viewed timely which not only delays the insurance credentialing but the process never progresses.
You need to keep taking follow-up with the insurance companies as a common problem with the credentialing process is if an application is stuck due to a reason and not viewed again, then it will be automatically rejected, leaving the applicant to begin the process all over again.
To mold the situation in your favor, you will need to call the insurance companies to whom you have sent your application, emailed, or faxed to know the credentialing application status of your application after every few days.
5. Consider taking professional help
The lengthy process of insurance credentialing can get on your nerves and can easily elevate frustration if the process gets delayed without any official reason. For this, it is better to take professional help from a medical credentialing service provider. With this, you not only save money in submitting your applications, taking prints, gathering documents, etc. but they can also help save your time in getting approvals. This means that you can start seeing your clients sooner than you could have expected as the service providers are experts and know the requirements of each requirement of insurance credentialing.
Frequently Asked Questions (FAQs)
1. Do I need to get a license before getting on to the insurance panel?
Not only license but insurance companies also need fully licensed practitioners before they approve someone onto their panel. The requirement may differ according to jurisdiction but providers with a license intern-level or intermediate level may not be credentialed under an insurance panel.
2. What is the estimated time for a provider credentialing process?
If the documents are complete and the application is error-free, then the process usually takes 90-120 days maximum. However, if a provider wants to open up a practice privately, they don’t need to wait for approval, they are allowed to see patients and submit claims once they are approved.
3. How to get credentialed as a new provider with insurance companies?
Every insurance company relies on some required documents. These documents can vary from state to state and jurisdiction. Make sure to fulfill the aforementioned requirements and any other state requirements to get credentialed with an insurance company.
4. Why does a provider need to be credentialed?
Before a health organization or a healthcare provider claims bills for the services provided to an insurance carrier, they must be credentialed by the insurance carrier. Credentialing is an essential part to assess a provider’s qualifications and skills required for the competency level.
5. How does the credentialing process take place?
The process begins with the assessment and verification of the physician’s training, education, and experience. The process enables patients to ensure that their health is in safe hands and for the peers of the physicians working together in the same organization that is surrounded by competent individuals. In addition, credentialing help in the enrollment of health plans so the reimbursement of the services can be managed.
6. What are some credentialing methods?
ANA studies elaborate on seven methods of credentialing which include;
- Recognition and
7. Name the types of services that can be credentialed
Types of medical services that can be credentialed include;
- Freestanding Surgi-centers
- Home Health Agencies
- Sleep Medicine Centers
- Skilled nursing facilities
- Hospice Centers.
- Community Mental Health Centers.
7. Who is eligible to perform credentialing?
Credentialing process involves a range of steps in establishing a firm report that the provider has the required skills and qualifications required for the position. Verifying the license and qualifications requires communicating with several organizations such as licensing boards, medical schools, CAQH, and many other bodies.
8. What credentialing is required in the medical industry?
Credentialing requires three academic verifications;
- Secondary School Diploma (high school)
- College Diploma/Bachelor’s Degree/Master’s Degree
- Doctorate/Ph.D. Degree.
9. How is insurance credentialing different?
With insurance credentialing, insurance providers verify training, education, and professional career in the applied medical field to ensure that the provider meets the requirements to be approved and served as an in-network insurance panel healthcare provider.
10. How much does it cost to be credentialed by an insurance company?
Generally, the affordable cost of the credentialing session by an insurance company lies between $2000-$30000 on average per annum. Due to the lengthy process of credentialing, the cost of the certification process gets higher. Also, documents that are submitted with applications are even at a high risk of theft and loss if they are not properly worked.
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