How do you get your insurance credentialed?

February 17, 2020

Credentialing has become a part and parcel of the medical profession. Getting yourself credentialed with the insurance companies is becoming necessary these days as it ensures ease of doing business. It can be confusing for some while overwhelming for others. But undoubtedly it is a lengthy and complicated procedure which cannot be avoided by medical practitioners.

Through the credentialing process, the insurance companies verify your education, training, and professional experience to ensure that you meet the internal requirements that have been set up by them for serving as their in-network provider and be listed on their panel.

The insurance companies provide web-based directories listing all the in-network providers of their insurance policies. These equipped directories are updated from time to time and are used by the consumers to locate the desired doctor for their treatment who accepts their insurance.

Once the medical practitioner will be registered, it becomes easier for the patients to locate the desired doctor in their area or according to their specialty. It can increase the revenue of the doctors as they can easily verify the insurance policies of the patients and can settle the claim of the treatments and receive payments quickly. Credentialing is important for a smooth revenue cycle. 

The process of insurance credentialing 

1.The first and foremost step is to identify the insurance providers with whom you should get credentialed. The best way to identify them is to ask your peers or seniors who are already in practice. The practical knowledge can prove to be highly valuable.

2.Once you have got the list, contact the insurance provider and enquire about the credentialing process and get the credentialing application forms to be filled.

3. Complete the application and provide all the necessary details about your education, training, practice, specialization, etc. and attach the relevant documents.

4. Make sure that your CAQH profile is up to date and all information has been provided particularly the information about practice location. Copies of all required documents like the license, insurance, board certifications, etc. should also be provided.

5. Retain a copy of the application form for your future reference. 

6. Once you have completed the application form and submitted it, follow up with the insurance company regularly to ensure that it has been accepted in the desired manner. 

7. Review the contract to see the details of the provider and check up on the fee schedule and all the contract terms.

Well, the entire process is a lengthy one and involves a lot of steps and follow-ups. This leads to wastage of time and efforts of the medical practitioners as they have to spend a lot of time in filling the applications and following up with the insurance company to ensure that the application has been duly accepted or not. Getting credentialed is important because it increases the revenue and provides the medical service provider with all the updated details of the practitioners. 

The process takes almost 2 to 6 hours for each application and further, more time in following up. The medical practitioners can instead spend this time on treating the patients by outsourcing this process to experts who can perform the entire work for them at nominal charges. At times the credentialing process may even take several months to complete as the insurance company might not be accepting new applications on their panels or the network might not be accepting any application in your service area. In such a situation you might have to apply after every 6 months. Even changing the employers may demand fresh application depending on your contract.

Credentialing with HRX

HRX provides specialized credentialing, enrolment and licensing services which can eliminate the frustration of the paperwork and time spent on the application process by handling the entire work for you. It provides expert services in credentialing along with CAQH registration which involves registration with the Universal credentialing Data source. So even if you are new to the practice or you have years of experience, HRX can help you in the best way by making the entire process easier and quicker for you. 

The firm has worked with over 10,000 healthcare professionals from the last 10 years and along with the initial credentialing, it also helps you keep a track of the expiring documents. Credentialing has to be revisited and updated after every 3 to 5 years and with HRX even that can be done easily. So if you are already worried about the credentialing process, get in touch with HRX to avail the best services.

By: hrx portal Category: blog