Becoming an in-network with insurance companies means that a healthcare provider has contracted with multiple insurance companies to provide healthcare services to the insurance company’s members at a negotiated rate. When a healthcare provider becomes an in-network provider, they agree to accept the insurance company’s reimbursement rates for covered services, which are typically lower than the provider’s regular rates. In exchange, the insurance companies lists the provider in its network of providers and directs its members to seek care from those providers to receive the highest level of insurance benefits.
By becoming an in-network provider, healthcare providers can expand their patient base and ensure that their services are accessible to a wider range of patients who are covered by these insurance companies. This can be beneficial for both the provider and the patient, as it can result in lower out-of-pocket costs for patients and increased patient volume for the provider. Following are general steps to become in-network with insurance companies:
Becoming In-Network with Insurance Companies
1. Obtain NPI and Other Necessary Credentials
Obtaining a National Provider Identifier (NPI) is an important step for healthcare providers who plan to participate in insurance networks. Insurance companies and government programs like Medicare require healthcare providers to have an NPI in order to bill for services. Without an NPI, a provider cannot participate in insurance networks. Providers must be licensed to practice in the state where they will be practicing. This includes maintaining a current license and any necessary certifications, such as board certification.
2. Get Malpractice Insurance
Malpractice insurance is a type of insurance that provides coverage to providers in the event that they are sued for medical malpractice. Becoming an in-network provider often requires malpractice insurance because insurance companies want to ensure that their network providers are adequately covered in case a patient files a malpractice claim against them. Malpractice insurance can help protect healthcare providers from financial ruin by providing coverage for legal expenses and damages that may be awarded to the patient. Even the most skilled and careful healthcare providers can make mistakes, and malpractice insurance can provide peace of mind and financial protection in the event that something goes wrong.
3. Make a List of Insurance Companies
As a healthcare provider, it is important to get credentialed with insurance companies that are widely accepted by patients in your area.
Here are some factors to consider when deciding which insurance companies to get credentialed with:
- Geographic location: Different insurance companies have different levels of coverage in different geographic areas. It is important to research which insurance companies are widely accepted in your area.
- Patient demographics: The patient population you serve may have certain insurance preferences. For example, if you primarily serve elderly patients, you may want to consider getting credentialed with Medicare and Medicaid.
- Insurance plan types: Different insurance companies offer different types of insurance plans, such as HMOs, PPOs, and EPOs. It is important to understand which plans are most commonly used by patients in your area.
- Reimbursement rates: It is important to compare reimbursement rates between insurance companies. You may want to prioritize getting credentialed with insurance companies that offer higher reimbursement rates.
- Administrative requirements: Each insurance company has its own set of administrative requirements for credentialing. You may want to prioritize getting credentialed with insurance companies that have a streamlined credentialing process.
It is also important to regularly review your list of credentialed insurance companies and consider adding or dropping companies based on changes in patient demographics or reimbursement rates.
4. Open CAQH Account
The CAQH application process streamlines the provider in-network process for healthcare providers and allows them to submit their information once to be shared with multiple insurance companies, instead of having to fill out separate applications for each insurer. Insurance companies use the information provided on the CAQH application to verify a healthcare provider’s education, licensure, certifications, and work history. This helps ensure that the provider meets their standards for quality care and compliance with state and federal regulations.
5. Contact Insurance Companies
Once you have completed your CAQH application, it is essential to reach out to the insurance companies you wish to work with. It is possible to evaluate the contract and fee schedule before registering as a provider. Before agreeing to any terms, make sure that you are well-versed in the contract requirements and that it aligns with the needs of your business or practice. Occasionally, certain insurance providers may require you to tend to emergency patients within a specific timeframe, have a 24-hour answering service, or prohibit you from delegating certain services. Besides the CAQH form, you may be required to complete additional forms. It is beneficial to be accurate and attentive to detail to expedite the approval of your application. Any errors, such as a missed signature or an incorrectly filled-out page, could cause significant delays.
6. Follow up with Insurance Companies
Insurance companies often misplace provider applications or place them in a state of uncertainty. This can be problematic because if an application remains in this state for an extended period, it might expire and get rejected automatically. Thus, providers are forced to restart the process from scratch. To avoid such scenarios, it is recommended that providers contact insurance companies each time an application or document is sent via fax, email, or mail. Providers should check on the status of their credentialing applications by contacting each insurance company every two weeks.
7. Response from Insurance Companies
Once the review process is complete, insurance companies will notify the provider of their decision, either approving or denying the application. If approved, the provider will be added to the insurance company’s network of approved providers. If the application is denied, the insurance company will provide a reason for the decision and may offer an opportunity for the provider to appeal the decision or submit additional information or documentation to address any concerns. The response of insurance companies will depend on various factors, including the completeness and accuracy of the application, the provider’s qualifications and experience, and the specific requirements of the insurance company.
About Medical Billers and Coders (MBC)
We hope this step-by-step guide on becoming in-network with insurance companies would be helpful for you. Medical Billers and Coders (MBC) is a leading revenue cycle management company providing complete medical billing and coding services. We can assist you to get in-network with Medicare, Medicaid, and all major commercial insurance companies in your area. Our credentialing services are designed to help providers streamline their credentialing process, reduce administrative burdens, and ensure compliance with regulatory requirements. To know more about our provider credentialing and enrollment services, email us at: firstname.lastname@example.org or call us at: 888-357-3226.