Credentialing for Optometrists with maximum Insurance Firms

As per the last US Census Bureau report, almost 84% of the country’s population is covered under health insurance, and thanks to the Affordable Care Act, this number is growing rapidly.  Hence it is important for optometrists to be credentialed with a good number of insurance firms as it adds to the revenue.

However, credentialing is a tedious process and can often turn out to be a formidably daunting task. With over 30 pages in the Medicare application form for solo providers and almost double that number, if you are a corporate entity or established group practice, it can be quite a nightmare.

For an optometrist who plans on treating patients, the healthcare plan must state clearly that the providers are credentialed. There are several criteria for credentialing optometrists.

  • The primary requirement is a degree in optometry acquired from an accredited university.
  • If working independently, the optometrist needs to hold certification for prescribing diagnosis drugs.
  • Optometrists also need to have access to 24-hour coverage for all Plan patients needing treatment for Ocular Disease.
  • They should have well-equipped facilities and be sufficiently staffed in order to provide the best services.
  • Any queries regarding professional history need to be answered promptly and relevant information should be made available thereby absolving the Plan or personnel from liabilities.

The credentialing process needs to be certified by the National Committee for Quality Assurance (NCQA). All documentation, including history and data, needs to be validated and submitted to the Credentialing Committee.

  • The credentialing process is usually completed within a maximum of 30 business days, provided a complete application is submitted.
  • Upon approval, the optometrists receive notification in writing within 3 business days from the date of approval.
  • The administrative processes are streamlined and do away with any delays in completing credentialing for multiple health plans at one go.
  • Credentialing applications can be submitted online, eliminating the need for printing and mailing hard copies of applications.
  • Updates, if any, can be made online within a matter of minutes, thus doing away with cumbersome paperwork.

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