Physicians and insurance carriers complement each other. One can have a large influence on the other. In fact, it would not be incorrect to state that one can make or break the other’s potential client base. However, providers and payers usually follow the “you scratch my back and I scratch yours” policy. They know that if they work together they can grow together.
Physicians actually have to credential or attest the competence of the insurance carrier and once this is done, the insurance carriers can tie up with physicians. Similarly, insurance carriers also credential physicians. There are third parties who help in the credentialing process so that physicians and insurance carriers can offload this role to experts.
Importance of Credentialing
In a scenario when a claim is raised and the payer finds that the provider is not properly credentialed then they can refuse to pay. Hence, in this situation it is vital that physicians get credentialed so that they can have a contract with the insurance carrier. Insurance carriers also play another important role; they can help physicians with references. If the provider is on good terms with the insurance company then they can recommend the physician to its clients and if they are comfortable with him he can become their primary care physician (PCP).
Many insurance plans limit the set of providers that one can choose from; or they might provide financial incentive for their clients to select a physician from a particular list. Patients also need to make sure that their physicians have a contract with the insurance company that is covering them so that they can get reimbursed later on.
On the other hand the physician can recommend particular insurance providers to their patients. Physicians can tie up with insurance companies which might not be as well-known or might have a higher premium but they might be covering more ailments or might have better coverage terms so physicians could tie up with them and advise their patients to tie up with that particular insurance company. Also, physicians should keep in mind the fact that the patients would benefit if the new insurance company has more coverage. As a matter of fact, many patients would not mind signing up with new insurance carriers if they get more coverage, with a better facility; in such cases they would not mind paying a bit more.
In conclusion, one feels that being properly authenticated helps in smooth operations as well. It becomes easy to raise claims and collect payments. Here is where an association with MedicalBillersandCoders.com will help. They can take over the administrative tasks and make sure that proper contracts are in place so that payments are not hampered. Furthermore, with their vast experience in revenue cycle management they can actually suggest the correct insurance carriers with whom the physicians should associate.