One of the biggest challenges, which also has a direct impact on the revenue collection of most practices, is credentialing i.e. enrolling with the best insurance service provider. This is not really as simple as it sounds. With so many insurance providers having opened shop, it is not easy to tell which one would be the best for a particular medical practice. No wonder then that most practices prefer to outsource their credentialing services as this would mean one less thing to worry about.

Are you still indecisive about whether to outsource your medical credentialing?

Well, take a look at these pointers which will help you understand when the time is right to outsource your practice’s the credentialing process.

1. Big process

Collecting the necessary details from the patient and other stuffs are a big process which should happen flawlessly. If the billing service staff is employed to collect all these details then it is pretty hard for that single employee to take care of all such things. So it is better to connect with insurance service provider.

2. Lessen your burden

When you take a step forward by implementing software and appoint an insurance provider employee for claiming reimbursement then it becomes an easy task for everybody. Every employee will have his own work to do. The number of workforce will also be increased along with that the technology will also be implemented.

3. Experts on role

If your healthcare industry is less experienced in such insurance stuffs leaving them in experts hand can lead to no denials or rejections of claims. Experts will do their job professionally and minimize the risks of rejections in claims.

Here, you will find our Step-by-Step Physician Credentialing Process

1) Week 1 Strategy and Information Gathering

a) During the first ten days or so after signing an agreement, our team will work with you to massage your payer list and ensure all relevant payers are included.

b) In addition to the payer review, your account manager will work with you to ensure we have everything needed to submit and process your applications.

2) Weeks 2-5 Application Submission & Follow up

a) During this time we will contact all insurance companies and begin the application process.  Some of them require an LOI (letter of interest) and others want you to submit a form on their website.  Regardless of how they do it, we will take care of all of this.

b) Once the requests to join the network have been submitted, this is when the follow-up process starts and continues until everything has been finalized.

3) Weeks 6-9 Follow-Up & Contracting

a) During this period we will continue to follow up and should begin to see your application making it through the payers credentialing process.

b) Once your application has made it through the initial process, we will now ensure it transitions smoothly into the contracting phase.

4) Weeks 10-16 Contract Negotiations & Effective Dates

a) This is when things start to get fun.  Agreements are coming in and you’re beginning to see some results.  Payer agreements are reviewed and submitted to you for signature (if they don’t need to be negotiated).  Once signed, these executed agreements are returned to the payer for loading.  The loading process with some payers can take an additional 30-45 days.

b) Finally, we will work through your payer list and ensure we have effective dates and provider IDs for all applicable payers.  We will then work with you to provide this information to your billing company or department.

EndNotes:

Outsourcing your credentialing is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious really worth it? That’s really what you must ask yourself. Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days whereas most of our payers are completed in 90 days.  Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

If you have any questions write us @  support@wonderws.com   or Schedule a 30 minute Complimentary live demo on our customized credentialing solutions.

Whether it’s a simple human error or an inefficient process, making a mistake could impact your bottom line. These processes may be time-consuming and arduous, but it’s they’re absolute necessities for your practice. 

Unfortunately, it’s easy to make a mistake during these function.

The sooner your credentialing mistakes are taken care of, the sooner you can focus on the day to day issues of serving patients and receiving timely payments. Ignore the significance of provider credentialing at your own risk it is certainly one of the most important compliance issues that a medical practice encounters.

To help achieve that level of perfection, here are the four biggest mistakes you should avoid during the credential process:

1. Not Completing/Incorrect Applications
2. Neglecting To Follow Up
3. Waiting To Start The Process
4. Not Assigning Roles To Your Staff

1. Not Completing/Incorrect Applications

• If you want to avoid denials and delays, you need to make sure that an application does not contain any errors and are filled out entirely.
• A credentialing application will ask for important pieces of information such as contact information, employment history, phone numbers, and other important records.

2.  Neglecting To Follow Up

• In order for credentialing to be a successful process, an organization needs to continuously follow up with its payers.
• You need to stay on top of them to ensure they are processing your applications in a timely fashion.  
• Don’t be afraid to reach out to them to check on the status of the applications.
• Try to get in the habit of contacting them on a routine basis to monitor the status of your submissions.

3. Waiting To Start The Process

• There is no time for procrastination in the credentialing process.  
• You need to get the train rolling as soon as possible.
• It can take a while to complete a thorough background check of a doctor, so you  will want to give your organization at least a couple of months before any doubts set in just in case there are any issues.

4. Not Assigning Roles To Your Staff

• Since there is so much that goes into the credentialing process, you need to have a competent team in place to ensure it is always running smoothly.
• All too often, organizations do not assign roles for staff members to manage the workload.
• For example, you need people who will enter data/ensure its accuracy.  If there are loosely defined responsibilities within your organization, it will cause errors which will lead to denials and delays.

Ultimately, the best way to prevent mistakes that can hinder or even derail the #credentialing process is to utilize specialists familiar with the entire process. Our skilled experts will work with you to streamline and speed up your credentialing process. 

Contact us for more information for more customized credentialing options suitable for your practice needs.

Credentialing includes a review / registering a doctor’s completed education, training, residency and licenses with any certifications issued by a board in the doctor’s area of speciality.

This is definitely a time-consuming process, and often takes up to six months to complete. The reason for the lengthy process is the requirement for submission of extensive background information.

In the past, each provider had to be individually credentialed with each individual health insurance plan. For some, this is still the case. Many health insurance companies, however, are now using a centralised database.

Who does not need to be credentialed?

1. Physicians billing under another provider’s number (locum tenens).
2. Urgent Care providers seeing only commercial insured’s (not govt) (may vary state).
3. Facility-based providers (R.A.P.E. – Radiology, Anaesthesiology, Pathology & Emergency medicine).
4. Self-Pay practice physicians”Concierge” medicine.

How is it done?

WWS team of Credential Experts enrolls or credentials hundreds of providers every year with insurance plans across the country.

Whether it is Medicare, Medicaid, the various commercial insurance plans, or even the various worker’s compensation networks, our team of credentialing experts have decades of experience and will ensure your practice receives the care and attention it deserves.

Steps for Streamlining Provider Credentialing Process:

• Developing an integrated approach to provider credentialing:
• Make provider enrolment an integral part of the revenue cycle program.
• Avoid credentialing and provider enrolment mishaps.
• Enhance credentialing process with KPIs.
• To Know More On How Credentialing & Contracting Can Be Less Time Consuming and More Effective More @  http://localhost/main-site-update/healthcare-provider-credentialing-usa/