How to credential a group practice?

COVID-19 pandemic has made a drastic impact on the healthcare industry. Some licensed providers are returning to a partly insurance-based model of private practice because of the lack of private pay patients. If you are running a group practice then you have multiple questions regarding credentialing, like how to credential a group practice? Do we need to enroll all rendering providers as employer models or reverse contractor models? And many more…

This blog is going to outline the information on group credentialing so you can make the best decision as you continue growing your private practice.

The partly insurance-based model creates a lot of insecurity when it comes to payer credentialing and how to structure a group practice with insurance.

Medical Credentialing is an Important for a Successful Practice

Several healthcare providers think that credentialing services are pointless or even an interruption to their day-to-day operations, but the fact is that they are more important to the healthcare industry than ever before.

Medical credentialing is the process of making sure that providers are in compliance with obliged regulations. In many cases, it means, medical credentialing means communicating with insurance providers so that healthcare providers can accept third-party insurance patients for their services to provide treatment. This way providers can increase their collection.

Our credentialing service specialist works closely with group physicians, solo physician offices, and ambulatory surgical care facilities in addition to payers and credentialing verification organizations with all required documentation submission processes.

Group Practice Credentialing

To get all group members credentialed with payer – then yes, it is likely individual credentialing will need to be completed. If you’re being independently credentialed, you might just need to add other physicians as rendering providers.

As a group practice, group credentialing comes with the biggest benefits to being credentialed us that if anyone provider leaves the practice or group, the credentialed enrollment does not revoke with them. Therefore, groups are not paying to credential their employees only have them leave.

Let’s take an example of the BCBS of Texas Provider Onboarding Process.

Physicians, Professional Providers, and Hospital/Facility-Based Providers

  • First, you need to complete the Provider Onboarding Form
  • Providers who want to be in-network will have additional fields to complete on the form.
  • Providers can select the question mark icon where available if they need assistance with those fields.

For Professional Providers

  • If you do not already have a Provider Record ID established with BCBSTX that matches your billing information (Rendering NPI, Billing NPI, and TIN), you will need to complete the Provider Onboarding Form.
  • A complete signed, and dated W9 and a copy of each provider’s license is required with all new group and solo practitioner Provider Onboarding Form submissions.

Group Providers

  • Complete the Provider Onboarding Form using the group information. Complete the required Provider Roster for providers that need to be affiliated with your group Tax ID and Billing NPI. (For existing groups – please only send new providers and not a full roster)
  • You must download the required Provider Roster and submit in the provided format.
  • One Tax ID per onboarding request.

How to Make Your Job Easier?

More than anything else, our medical credentialing professionals will give you peace of mind. You can rest assured about your group practice credentialing. Your provider’s job is to provide services to their patients. They should not have to feel lost like they do not need to solve an insurance issue.

Hiring our expert professionals in group practices credentialing helps make your job easier. You can rest assured with our credentialing team who will take over the process for you.

If you’re looking for medical billing or credentialing help, consider Medical Billers and Coders for credentialing services. We are available to offer a timely quote or help you find a solution. You can reach us at 888-357-3226 or by filling out this quick and easy form here.