For many licensed medical professionals, Medical Credentialing is known as

1) “the process of becoming contracted with insurance companies”, or

2) “the process of getting on insurance panels”, or

3) “what you need to do to be able to accept insurance.”

If the process of credentialing is done carelessly, or passively then a few important details could be missed about the particular physician in question. When the process of credentialing is skipped, then it could spell doom for your practice by causing cash flow issues, scheduling hurdles and in extreme cases, putting the well-being of patients at risk.

How do I Become Paneled with Insurance Companies?

The idea behind medical credentialing is simple. You (the medical provider) choose which insurance companies, EAP, or the government programs (Medicare, Medicaid) you want to work with. You apply to be a “networked provider.” You get approved and begin seeing patients.

Ok, Medical Credentialing isn’t quite as easy or simple as it sounds. The process gets a bit more complicated when you take a closer look.

Either way, the point is no medical practice wants to have issues with credentialing in order to avoid trouble in the future.

So what are some ways that can help reduce problems when it comes to credentialing?

Medical Credentialing Steps:

1) Decide what insurance companies you want to be a provider for.

If you’re not sure what insurance companies you want to work with, start with the major ones: Blue Cross / Blue Shield, Aetna, Cigna, United Healthcare, Tri-Care, Medicare. A good way to identify what plans are popular is to ask some friends and colleagues what insurance they have personally. Alternatively, you could call a medical practice in your area and just ask them what insurance companies they serve they’ll probably tell you.

2) Contact insurance companies to request a provider application.

This can be harder than it sounds. Expect to spend about 30 minutes on hold, only to then be told to call another number, or get someone’s voicemail, or (about 20 percent of the time) find that no one is available and there’s no option to leave a message

3) Complete and submit the provider application.

Once you receive the application, complete it fully, make a copy and then send it back.

4) Stay up to Date with CAQH

CAQH is an abbreviation for The Coalition of Affordable Quality Healthcare who began their uniform credentialing 15 years ago. Since their program kicked off, it has attracted admirers from all over the country with most medical practices picking it up. Physicians who stay up to date with CAQH find the credentialing process much easier than those who do not.

5) Linking a Physician’s Start Date

It would be great for the practice if the new physician’s schedule can be filled soon enough. Linking a physician’s paperwork submission dates to their contract is therefore very important.

6) Complying with State Regulations

Different states have different legislation that governs medical credentialing services. Therefore, it is important to get in touch with your state medical group association or your medical society in order to ensure that you are practicing within your state’s standard. You also want to observe interstate reciprocity regulations such as a partial credentialing process for physicians changing practices within the same state.

Contact us for more information for more customized credentialing options suitable for your practice needs or to read more about Provider Credentialing visit our article.

But Durable Medical Equipment businesses have their own set of unique hoops that they must complete before they can successfully open their doors.

In your practice, you have to make sure that your clients or patients can pay for the services that they receive. In most small businesses, customers hand over plastic and payment is received, but in mental health, when clients hand you plastic, most often – it is their insurance card.

The burden falls on you to:

1. Accept that insurance

2. Bill that insurance

3. Receive the funds from that insurance card.

How do you make sure that you can do the above 3 things? It is a simple answer but a difficult process, “Provider Credentialing”.

Many DME Companies are starting to be credentialed because of the health care reform. With everyone needing insurance, people are going to want to pay DME providers with insurance.

Many different credentialing things are DME credentialing, provider enrolment, Insurance credentialing, Medical credentialing, getting on insurance panels; It means that you have become “in network” with the insurance companies. Once you receive provider credentialing, you can now bill the insurance and receive your payments as an “in-network” provider

If you are interested in getting your Durable Medical Equipment Company credentialed call WWS at +1(302) 613-1356, and we will be happy to help

Who should you participate with? Who should you credential with?

This is not a general answer. Sure, there are some big names that you want to get in with: BCBS, Aetna, UHC, Cigna, Humana, and the list go on and there are important governments companies that you may want to get networked with: Medicare, Medicaid, Tricare (Tricare changes names based on the location that you are in).

But, there are also some smaller companies that are unique to your area that you will want to credential with. Some people do not think about provider credentialing with the small companies, but in the end they could pay out the most dividends.

Being in network with some of the smaller companies gives you access to clients and potential customers that will see you because no one else can. Being provider credentialed with BCBS is great, but there are thousands in your area completing provider credentialing with BCBS. So the next best thing, seeking provider credentialing with the smaller companies where there is no competition.

When do I start the provider credentialing process?

Start the provider credentialing process early on.

First, it is best to get an office space, a business bank account, and a business organisation together, but go ahead and plan the credentialing process. When getting into credentialing, it is the best to have a location mapped out, but the location can be changed without a huge.

Next, get all of your information ready. You will need license information, background documents, insurance, copies of relevant information. A realistic time frame, for DME provider credentialing is around 90-120 days.

Each insurance carrier will have their own process, but first you must go through the process of “credentialing”. Credentialing means they verify everything about you. When that is complete your file with all of your credentialing materials goes to a committee and you either pass or fail. This is a 90-120 day process.

Once you get approval, then you can move into contracting. Contracting is the point where you receive the ability to be in network. You can review the contract from the insurance company and negotiate a favourable rate before signing. When you submit it, it will then take 30-60 days before you get a welcome letter.

Also, it is important to note don’t expect the insurance to backdate your claims. when you are getting provider credentialing, do not expect the insurance company to accept your previous claims you can not submit the claims till you are in the network you will be considered as out of network.

 How do I start the credentialing process?

WWS team of Credential Experts enrolls or credentials hundreds of providers every year with insurance plans across the country. Whether it is a Medicare or Medicaid, the various commercial insurance plans, or even the various worker’s compensation networks. Our team of experts have decades of experience and will ensure your practice receives the care and attention it deserves.

Conclusion

Provider credentialing process is more necessary for the DME Companies to getting your practice. It is the difference between barely making it and thriving. While it can be time consuming, we can help. Let us focus on what we do best, so you can focus on what you do best. If you would like us to contact you via email or Schedule a 30 minute complimentary live demo on our customised Credentialing solutions http://localhost/main-site-update/live-demo/