Health insurance contracting and credentialing is one of the first things that you will need to do to build and grow your private practice. We know that is a big hill to climb! Accordingly, here are a few steps that you can take in order for you to become contracted and credentialed. In light of this, the first question to ask is:
What insurance companies do you want to be contracted with?
Insurance Companies
At first, look at your prime demographic and determine what health insurance companies they are most likely to use. Reach out to these health plans and gather information on what documentation they will need to offer you a contract.
As a matter of fact, the best way to do this is to call their insurance contracting and credentialing department or “provider Line” and ask for your area representative’s contact information, how long the process generally takes, and if they have an opening for your medical specialty.
NPI and CAQH
At the same time, obtain an NPI (National Provider Identifier) for yourself and the facility or group. This NPI is a 10-digit number that identifies the provider with the Medicaid and Medicare services. You can register here for an NPI at the National Plan & Provider Enumeration System (NPPES).
Equally as important, once you have your NPI and your tax ID number you will need to register with the Council for Affordable Quality Healthcare (CAQH). In order to do this, you will need your NPI, license number/ medical degrees, DEA information, malpractice agreements, all education and demographic, as well as your practice information. Insurance companies use CAQH to verify your information as a medical provider. Once you have completed and attested to your profile, you will then receive a CAQH number.
You will need to follow this step for each individual provider in your practice.
Applications
Finely, you are ready to fill out the application and submit it for review. Undoubtedly, you need to save digital copies of all of the applications!! You will be surprised how often insurance companies “lose” your application. You will need to follow up regularly with the insurance credentialing department to find out:
- What the status of the application is
- The time frame that it will take to approve your application
- When does the board meet, to approve applications
From my experience, this process can take up to 6 months. In this case, the key to being successful is to constantly follow up and check on the status of your application.
Review, Negotiate, and Sign
Once you have been offered an insurance contract make sure that you review ALL terms of the agreement. Make sure that you can offer the services with the fee schedule in the contract, be able to adhere to the site visit requirements, and submit and correct claims within the allotted time frame. Check the fee schedule to make sure covers all of the services /CTP codes that you will be offering and acceptable fees.
If you find that you would like some of these terms adjusted or modified reach out to your area contact and see if an adjustment is a possibility.
When both parties agree with the contract, then go ahead and sign it. Return it to your representative for the return signatures. Keep a copy of the signed contract. No doubt you will refer to this document often. It is good practice to periodically review and update fee schedules and contracts if necessary.
Credentialing
After the contract has been signed, the insurance company will ask for all the provider NPI, CAQH, license number, and other information to start the credentialing process for each individual provider. This process takes a few weeks/ months to complete. It will go much faster if you keep in contact and check on the status of the credentialing. When a provider is approved, you will receive a “welcome” letter that indicates that the provider can now start seeing patients. Keep a copy of this letter in their employee files.
If you are new to the process of contracting and credentialing it can be a lot of work. Take your time and complete everything. If you are not sure how to answer, then reach out to your representative and find out what they are asking for. Mistakes add considerable time to the process, consequently, it is important to get it right the first time.
If you would like us to help with this process we can be reached at 385-402-9015 or by our contact page.
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