Credentialing has become crucial for medical practices to survive in an increasingly volatile and competitive industry. Most American citizens today are covered by an insurance plan provided by some company or the other. If you fail to get credentialed with the insurance companies, then you will lose clients to your competitors. Hence, having the knowledge of the most popular insurance companies to get credentialed with becomes really crucial. When you begin credentialing, you can start with the largest payers, one of which is Medicare. It’s best to start with the largest payers first and work your way towards the smaller ones.
There are a few ways to determine which insurance companies in the USA are the biggest in terms of a client base. The crucial factors for determining the biggest insurance companies are: lives covered; company’s overall revenue; accessibility and most important company’s goodwill.
Most Popular Payers
The popularity of insurance companies varies depending on location. However, some of the most popular and largest payers are Medicare, BCBS, Tricare, Aetna, Cigna, United Healthcare, Humana, Coventry, Highmark, Health Net of California, Kaiser, Wellpoint, Wellcare, Regence Group, Value Options, and many others.
UnitedHealth Group:
The company is ranked 7th on the 2020 Fortune 500. As of 2019, it is one of the largest healthcare insurance companies in the world with total revenue of $226 billion, along with 115 million customers. UnitedHealthcare revenues comprise 80% of the Group’s overall revenue.
Anthem:
It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2018, the company had approximately 40 million members. Anthem is ranked 29th on the Fortune 500. The company operates as Anthem Blue Cross in California, where it has about 800,000 customers and is the largest health insurer. It operates as Empire BlueCross BlueShield in New York State and as Anthem Blue Cross and Blue Shield in 10 states.
Humana:
As of 2020 Humana had over 20 million members in the U.S. and reported a 2019 revenue of US$56.9 billion. In 2020, the company ranked 52 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky. It has been the third-largest health insurance in the nation.
Aetna:
The Company’s network includes 22.1 million medical members, 12.7 million dental members, 13.1 million pharmacy benefit management services members, 1.2 million health-care professionals, over 690,000 primary care doctors, and specialists, and over 5,700 hospitals. Since November 28, 2018, the company has been a subsidiary of CVS Health.
Cigna:
The Company ranked No. 13 in the 2020 Fortune 500 list of the largest United States corporations by total revenue. Cigna offers Medicare and Medicaid products and health, life, and accident insurance coverages primarily to individuals in the U.S. and selected international markets.
Each payer will have their own way of credentialing a provider; you must read the instructions on becoming part of their network. You can usually find guidance on how to join each payer’s network on their website. It’s best to outline each payer’s requirements, for example, whether they require certain forms (W-9, roster, request on letterhead, etc.).
Also, note whether they require you to email the necessary documentation to a designated credentialing address or fill out an online form to initiate credentialing through a platform such as Availity.
The time it takes from start to finish varies. For providers who are already licensed in the state, the entire credentialing process generally takes about 60–90 days. For those who aren’t licensed in the state, tack on an additional three to four months. Remember that new providers cannot start seeing patients until they have been licensed by the state.
Credentialing a provider requires attention to detail, constant follow-up, and follow-through. But there is no need to be afraid of credentialing; it is simply a systematic process that allows a new provider to bill a payer.
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