Step By Step Guide for Provider Credentialing

Have you credentialed yet? For healthcare professionals provider credentialing looks like a process of gaining network with insurance companies. It’s recommended to ensure better credentialing for widening their network with insurance panels. Following a process, expands your business in terms of profits as well as clients.

Earlier, the practices were depending only on the “cash only” process where as the present situation had made them concentrate on patient care and most importantly, patients and clients are more demanding to accept insurance for their payments. If it doesn’t work out, they will look for an alternative option.

Patients are well aware about the healthcare professionals who accept their insurance without uttering a word “no”. If you aren’t getting credentialed with major insurance companies, it means you are sending clients away including profits. In order to have new and existing clients with them, healthcare professionals must not delay provider credentialing with major insurance companies.

Process of Provider Credentialing:

  • Provider credentialing can be explained as retrieving and filing out series of applications with insurance companies, submitting applications to insurance companies and make sure if everyone has got the application and followed up frequently to track the application.
  • While it looks like the process has only few steps to complete, healthcare professionals describe the process as the most difficult one, because of slow running applications, resubmitting applications, fighting those rejections during enrollments, and spending much of time with insurance companies on holding processes.
  • Above all, insurance panels will mostly tend to claim that they are occupied and aren’t inviting people with particular specialty at that moment of time.
  • To the matter of fact provider credentialing isn’t much of what healthcare professionals expect to be but a process which each one of them should undergo.

Few Things to remember for easy Provider Credentialing process:

  • List out clearly
  • Be Prepared and complete CAQH
  • Spend few hours with Panels
  • Frequent Follow up

1.List out Clearly:

  • Ensure a quick research on insurance companies to find out which insurance companies are better for healthcare professionals to get credentialed with.
  • Not everyone follows the same process. The steps and the way of handling the provider credentialing process may vary from payer to payer.
  • Enquire about the variations that each insurance company might require according to the hoops healthcare professionals will have to jump through.

2.Be Prepared and Complete CAQH:

  • CAQH – The Council for Affordable Quality Healthcare often requires conjunction with any of the insurance companies’ applications to complete provider credentialing process.
  • Many major insurance companies follow CAQH as part of their application process. Points to note about CAQH application:
  • Healthcare professionals are to be invited: Well, we call it an invitation just because you can’t directly go and upload information on CAQH.

Healthcare professionals would need an invitation from insurance companies to join CAQH. It’s a bit complicated process as you would need to first submit application to insurance companies and follow up with them for CAQH number.

Later you are allowed to submit application to send it to insurance companies. Even though it’s U-turn process, it is must for insurance companies to complete your application.

  • Don’t choose to fill out CAQH on paper: CAQH usually provides healthcare professionals an option to complete application either on paper or online.

Never go for paper initially. First of all, the application consists of 50 pages and is printable only in colour.

Secondly, when paper submission to CAQH is done, data entry person must be separately hired to transfer the information. But we’re not sure whether they do a fine job!

Applying your application online is what we would recommend you to follow. Your CAQH will be completed without any delay.

  • Write a perfect Resume: One of the trickiest parts of getting a CAQH application is uploading perfect and accurate resume. Firstly ensure whether the dates of employment and education are mentioned in correct format.

If dates aren’t posted correctly, the application will be rejected and they won’t send it to insurance companies.¬† Ensure there are no gaps in employment history. The application should be filled with no gaps in between.

  • Don’t forget to re-attest: Re-attestation is as important and essential to complete your information on the profile. If not, this can create issues in accepting insurance as they will know the lapse in CAQH. As it would take few minutes and if you remember provider number, it’s easy to login and take care as soon as possible.

3.Spend few hours with Panels:

  • It’s evident that provider credentialing process is never going to end in minutes. It requires 10 hours of focused labour for the company you wanted to get credentialed with.
  • It requires the time that includes retrieving applications, filling out applications, organizing necessary documentation and following up with insurance companies on phone. Most of the applications are electronic; the majority has to be printed and to be done completely by hand.

4.Frequent Follow up:

  • Insurance companies often have the habit of losing applications or misplacing them elsewhere. Follow up process is very essential to keep our application safe and take it further for next process.
  • If application is stuck for more weeks, it automatically expires and gets rejected. So, healthcare professionals will have to call insurance companies for every application sent email or fax.
  • Frequent follow ups must be there to check up the application status.

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