How to get Credentialed with Insurance Companies as a New Provider

get credentialed with insurance companies

Are you confused about how to get credentialed with insurance companies if you’re a new provider in the field of medical billing? Whether you are an independent contractor, associate, counselor, therapist, or have your own practice, one of the main challenges to getting paid for your services is becoming credentialed with an insurance company. Now it’s necessary for providers to be credentialed because patients and clients prefer those providers that accept their insurance for payment. And if not then there are most likely chances to lose clients which ultimately cause the profit to be lost which they bring to you. That’s why it is crucial to be credentialed if you want to attract more potential customers. But keep in mind that it’s not just about gaining access to a broader patient base but also about establishing credibility and trust within the industry.

Here again, the place where we started on how to get credentialed with insurance companies? Don’t you worry we’ll discuss each step in detail. So let’s start it!

Understanding the Credentialing Process

Medical organizations credential, also known as physician, medical, or doctor credentialing, by verifying healthcare providers’ credentials to confirm they possess the necessary licenses, certifications, and professional background, ensuring they meet the standards required to provide quality care to patients.

Healthcare verification, a procedure that also applies to nurses and other medical professionals, often follows less strict protocols and typically associated with a doctor’s clearance. Now you may have a question on how long this kind of verification takes. The time frame varies; some insurers may complete the verification in 30 days, while others might take up to 180 days.

Steps to get credentialed:

Get your NPI number:

The Centers for Medicare & Medicaid Services (CMS) assign a unique identification number, known as the National Provider Identifier (NPI), to healthcare providers. Obtaining your NPI number is the first step in the credentialing process, as it serves as a universal identifier for healthcare providers. There are two types of NPI numbers: Individual (Type 1) and Organizational (Type 2). Before you are even hired somewhere or incorporate your own practice, it’s essential to get your Individual NPI. This number will follow you throughout your career, regardless of where you work or how your practice evolves.

Process to get NPI:

To get your NPI the process is simple just go to the website of the NPI Registry. Here you’ll see the application process that is very straightforward, you add the basic information like your name, contact details, professional credentials, and practice address if applicable. You may need to add some additional documentation about your practice including copies of your professional licenses, certifications, or other relevant credentials. Once your form has been submitted, you will need to wait for CMS to approve it. Usually, this requires a few weeks. Upon approval, you’ll be issued an Individual NPI number. This unique identifier will be yours for the duration of your career in healthcare.

Know How You are Billing for Your Services.

It’s important to know exactly how you are going to bill for your services before asking for credentialing. The credentialing process will go more quickly if you are aware of your billing arrangements, whether you are billing on your own, through a group practice, or as a member of a healthcare organization. 

  • Some chiropractors can choose to operate as sole proprietors using their own social security numbers. Under this arrangement, the doctor has full personal responsibility for all business-related matters, such as liability and billing.
  • If you are an independent contractor or practice owner, it is essential to discuss the billing structure with your employer, accountant, or lawyer. It is best to determine your billing structure before receiving credentials rather than later.

 After credentialing, any modifications to your tax ID number or billing arrangement can lead to problems and need you to restart the procedure. Re-credentialing with insurance providers will be required for any changes to your tax ID number or billing arrangement. This involves submitting applications again, including updated documentation, and undergoing the review process again.

Re-credentialing is an absolutely difficult and time-consuming procedure. Delaying your ability to submit service bills and receive payments from insurance providers can affect the cash flow and day-to-day operations of your business. It is possible to avoid issues and delays in the credentialing process by being proactive in your understanding of your billing structure early on.

Obtain Malpractice Insurance:

Malpractice insurance is a secure feature that is included at every medical facility when you visit a doctor. It functions as a safety net in case something goes wrong and someone wants to file an action or file a complaint.

A healthcare provider or hospital must provide proof of this malpractice insurance before they can work with health insurance companies. It is an important step in the credentialing process. The insurance companies request a document detailing the specifics of the malpractice insurance, including its coverage amount and validity dates, throughout this process.

Ensuring that the coverage in this paper matches the insurance company’s requirements is really important. If not, there can be issues in terms of delays or rejections from the insurance provider.

Complete the CAQH application.

The CAQH ProView program is widely used by insurance companies for the purpose of gathering and validating data on healthcare providers. With this simplified method, providers can submit their information using a single platform, which streamlines the credentialing process.

Providers can submit their data and finish the required documentation online with CAQH ProView. Paper forms and manual submissions are no longer necessary due to this digital method, which saves time and lessens administrative load.

It’s important to take proper time during the CAQH application process even if you are doing it online and gather all the necessary documents and information. This process can take up to two hours.

Your job history, malpractice history, education, training, license, and other details are all mentioned in detail on the CAQH application. Providing complete and correct information ensures quick and efficient handling of your application without any delays caused by errors.

Register with Medicare.

You need to register with the Medicare program if you want to take in Medicare patients. Completing the Medicare enrollment application and fulfilling the program’s eligibility standards are necessary steps in completing this process.

As compared to healthcare providers, Chiropractors do not have the choice to refuse Medicare.  They have to register with Medicare if you plan to offer services to any Medicare beneficiary, including young disabled people and seniors.

Chiropractic doctors can choose to enroll as a participating or non-participating provider when they sign up with Medicare. Each choice affects invoicing and reimbursement in a different way.

  • By choosing to become a participating provider, you accept full payment for eligible services from Medicare as determined by the authorized payment amount. This option offers certain advantages such as simplified billing and higher reimbursement rates.
  • As an alternative, you can choose to charge what you want for Medicare services by enrolling as a non-participating provider. It is your responsibility to bill patients directly, and you can be limited in how much you can charge even if you might get paid at a higher rate than participating doctors.

Chiropractic doctors who have enrolled in Medicare must follow the program’s guidelines to keep their enrollment status. This involves following billing procedures, filing claims on time, and complying with coverage policies.

Contact each insurance company with which you want to be in-network.

Now that you have finished your CAQH application, now you need to get in touch with each insurance provider you want to use. This step is essential to reach a larger patient base and become an in-network provider. Here’s what you should be aware of:

Examining Contracts and Fee Schedules: Spend some time going over the contract and fee schedule that an insurance company offers before agreeing to become a provider. Verify that the terms and conditions of the contract are clear to you and that they meet the needs of your practice or business. 

Follow the requirements: Insurance companies have specific requirements outlined in their contracts that you have to follow.  These requirements can include that urgent care patients must be seen within a specific amount of time, that a 24-hour answering service must be kept up, or that chiropractic assistants are not permitted to perform specific tasks.

Filling Out extra paperwork: Insurance companies can request you to complete extra paperwork unique to their company in addition to the CAQH application. Filling out these forms requires careful attention to detail and correctness; any mistakes or omissions might cause the credentialing process to take longer.

Accuracy and Precision: These two qualities are crucial while completing your application to insurance companies. Make sure all the information is exact before submitting since erroneously signed documents or pages might seriously impede the credentialing process.

It’s critical to keep up with any changes that could take place after you have your credentials and start charging insurance for your services. Keeping informed of policy modifications not only protects your revenue but also guarantees that your practice will continue to be compliant over time.

Frequently Asked Questions

Insurance companies assess and confirm healthcare professionals’ qualifications through a process called credentialing. To confirm that providers fulfill the requirements needed to take part in insurance networks, it requires presenting documents such as licenses, certificates, and other credentials. 

Credentialing is important for new providers because it enables them to join insurance networks, growing their patient base and improving access to medical care. Moreover, it also helps in building credibility and trust.

The credentialing process should begin depending on your choice ideally before starting your practice or landing a job with a healthcare institution. An early start is essential to prevent delays in the credentialing process which can take weeks or even months to finish.

The particular documents needed for credentialing can vary according to the insurance providers you want to deal with. Common paperwork consists of certifications of education, malpractice insurance, DEA registration, licensing verification, and training and experience records. 

You can finish the CAQH application also called CAQH ProView, online. It will be necessary for you to register, fill up your details, and provide supporting files. Make sure you provide enough time to assure accuracy, since the procedure might take up to two hours.

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