Opening a new health care practice needs time, patience, money, and perseverance. Healthcare businesses have their own set of unique tasks such as credentialing that place an additional burden on the practitioner.

For example- In a health care practice, your customers will hand you a plastic card (insurance card) to pay for your services. And the burden is on physicians or practitioners to make sure that the card is good, covers your services, and the company behind that card will pay your claim. How do you make sure your claim will be paid? The simple answer is "Credentialing".

What is mean by Medical Credentialing? 

Medical credentialing is the process of getting networked with insurance companies. If physicians aren’t credentialed with major insurance companies, then they essentially turning clients and the profit away. Moreover, Sloppy credentialing can spell cash-flow delays and more.

All healthcare workers should understand that practices don’t start overnight, practicing clinical medicine is a privilege, and it goes hand-in-hand with first being credentialed. 

Depend on the evaluation of the provider’s clinical qualifications, training, and overall performance privileges of practice are defined. This is followed after the individual is credentialed.

Now let’s understand who requires credentialing?

Who requires credentialing?

Any licensed, independent healthcare professional who has been permitted by law and regulated by a licensing organization to provide services and care without supervision or direction within the scope of the individual’s license needs to be credentialed.

Every state has unique laws regarding medical practice hence once a license is obtained, healthcare professionals can only perform a function for which they are granted privileges.

For example, an advanced nurse practitioner cannot independently start prescribing medications, or a family physician cannot begin inserting central lines.

Medical credentialing will probably never become your favorite pastime, there are a few things you can remember that will make the process easier:

Research the insurance companies

You need to research and make a list of insurance companies you want to be credentialed with. Every insurance company may require a different process.

Complete the CAQH

Major insurance companies include BCBS and Aetna, use CAQH as a part of their application process. Hence To complete one’s medical credentialing; CAQH, the (Council for Affordable Quality Healthcare), is often needed in conjunction with an insurance company’s application. 

Dedicate more time for every insurance company you wish to be credentialed with

Credentialing doesn’t complete in a minute; it takes a significant amount of time and focused labor for each company you want to be credentialed with. The hours it takes mostly for various processes such as retrieving applications, filling out applications, organizing necessary documentation, and following up with insurance companies by telephone. However, some applications are electronic, the vast majority need to be printed and completed by hand.

Following up for each company

Following up is an important aspect of the credentialing process as there are chances of applications not being reviewed properly or applications getting expired; Hence applicants need to call each insurance company every time an application is sent to them. 

Moreover, taking follow-ups about every 2 weeks, to check up on the status of your credentialing applications helps to check the status of credentialing applications.

Outsource Medical Credentialing

As the credentialing process is complex and time-consuming hence taking help from credentialing services serves to save money, alleviate the frustration and headache of the process. Reputable service will likely have better success getting you credentialed efficiently which means you can see the patients earliest.

We can conclude that the insurance credentialing process is critical to get a good start and ensure early positive cash flow. We can make this process smoother and streamlined for you as we have credentialing expert. Start early and expect nearly 45 to 180 days to get enrolled with all the carriers that are important to your practice.

Published By - Medical Billers and Coders
Published Date - Mar-17-2021 Back

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