Provider insurance credentialing is a complex and time-consuming process. Once you have decided to start the credentialing process, your first task would be knowing key payers to get credentialed with. Your second task would be listing payers who are difficult to get credentialed with. For some payers, the credentialing process is much more complex compared to others.
These payers might have 30+ pages of the initial application form or unclear document requirements or poor customer support. For whatever reasons, if the credentialing process is incomplete or tangled, your claims will be denied, payments delayed, and money will inevitably be lost. We have mentioned such payers with a difficult credentialing process.
Some of key payers to get credentialed:
Medicare
For Medicare, you have to start the credentialing process by submitting appropriate Medicare Provider/Supplier Enrollment forms. Some of the forms are CMS-855I, CMS-855B, CMS-855S, and CMS-855A. You can also use Provider Enrollment, Chain, and Ownership System (PECOS) to enter your enrollment application online.
Though Medicare takes approximately 60 days to process enrollment applications for individual providers that’s not the case most of the time. On the other hand, applications for facilities, DME companies, Home Health Agencies, Independent diagnostic testing facilities, and other organizations take longer as site visits add more time.
The time frame for application completion extends widely due to Medicare’s stringent enrollment requirements. If your application has errors it will extend the timeframe as Medicare would expect corrections or additional information. The Medicare revalidation project is causing many Medicare contractors to be overloaded with work and resulting in longer than normal turnaround times for applications.
The great thing about Medicare provider enrollment is that your effective date with Medicare will be the date the carrier receives your enrollment application no matter how long it takes them to complete the process. You can always back the bill if you are seeing Medicare patients before the completion of your credentialing application.
Medicaid
When you talk about credentialing for Medicaid, the first concern is each state has its own Medicaid program and different credentialing process. It’s well-known fact that Medicaid programs are notoriously slow for processing applications. Just for contracting a single provider, some states take six months or more.
Another difficulty for Medicaid credentialing is the paper-based application system. Some states provide electronic applications for credentialing but most of the states are stuck with paper-based systems. It’s really frustrating to deal with such states as your application might get denied for an unknown reason. The only option available to you is to start the credentialing process from the beginning.
Medical Billers and Coders (MBC) assisted hundreds of providers and practices for Medicaid credentialing. Based upon our experience, common reasons for denied Medicaid application are: Incorrect W-9 (for the individual provider: name and SSN, for a group: name and Tax ID); Name Mismatch (if a provider applies as ‘Benjamin J. Smith’ and provides a license that says ‘James Smith,’ the application cannot be accepted because of mismatching names); Incorrect Signature (for the group, the application must be signed by an authorized signer); and Missing Attachments (for electronic applications).
Blue Cross Blue Shield (BCBS)
Getting in-network with local BCBS is a lengthy and complex process. If everything goes right the entire process takes about 90-120 days but that’s not the case every time. Just like Medicaid, each BCBS has unique sets of programs and application processes. Most of the BCBS requires detailed paperwork and if you miss any document the credentialing process will get extended. Follow-ups are crucial for BCBS credentialing.
You can’t depend on them to tell you any additional information or document is required. Constant attention and follow-ups are required even though you are sure that you submitted the correct application. As most time is used in managing your practice, you may not give that amount of time and attention to BCBS credentialing.
Whether you can apply electronically or through paper, outdated payer manuals, missing crucial information on the website, different credentialing rules, need for follow-ups, the time required, and a lot of documentation are few reasons that make the above-mentioned payers difficult to get credentialed with.
Get ready for experiencing key payers to get credentialed with MBC
In such cases, it makes sense to outsource this important revenue cycle step to experts in provider credentialing like Medical Billers and Coders (MBC). MBC has assisted hundreds of providers and practices to get credentialed. Save your time by knowing key payers to get credentialed with our credentialing services, contact us at 888-357-3226/ info@medicalbillersandcoders.com
