Tips to credential a provider with insurance company

Tips to credential a provider with insurance company

Healthcare facilities, payer networks and hospitals require credentialing to admit a provider in a network or to treat patients at a clinic or hospital. What may look like a straightforward credentialing process is engulfed with complications that can frustrate even the calmest of physicians.

Here are some vital tips to credential a provider with insurance company

Allocate a Credentialing Coordinator

Whether you take care of your credentialing tasks in-house or assign them to certified medical billers and coders, allocating a credentialing coordinator to stay on top of deadlines is a smart thing to do. He/she can send timely reminders to make sure that nobody’s credentialing expires to avoid denied or delayed reimbursements.

Keep extra time for Credentialing

Normally,credentialing should take around 80-90 days, but smart medical practices keep aside a window of 150 days. Keep in mind that credentialing with insurance companies must take place on their timeline as each payer has its own credentialing timeline. Keep extra time for credentialing and you’ll be pleasantly surprised when it takes fewer.

Update staffers with Credentialing Program

The CAQH or Coalition for Affordable Quality Healthcare, a uniform credentialing program is being widely adopted by insurers. Doctors who regularly update and attest their information with CAQH tend to have more proficient credentialing and re-credentialing experiences. A prime example of updates is the outsourced medical billing service provider who have all the updates available with them hands on.

Link provider and submission date of Credentialing Forms

Most of the medical facilities require credentialing paperwork as soon as an employment offer is made. Still others link a new doctor’s starting date to paperwork submission. You could, for instance make a new starting date no lesser than 120 days after you receive his/her credentialing information.

Make a sustainable Credentialing Process

Making a credentialing workflow is challenging, but it helps practices in the long run. Your workflow should consist all required forms and documents, even when you outsource the credentialing process. A workflow to accommodate a multi-physician practice, with that of re-credentialing is always a cropping issue.

Don’t assume check the documentation trail

With some of the insurance company’s you can charge for a new physician whose credentialing isn’t complete by labelling them as locum tenens (a fill in physician form). However, not all the payers agree to it. It’s best to get the doctor fully credentialed so you can charge normally. But if you can’t, you need to contact payers to know about their policy on locum tenens billing.

Keep physician information updated

Do ensure that your facility credentialing coordinator maintains a complete and updated contact information of every physician. Without contact and mailing details, dealing with credentialing or re-credentialing can take longer time than it should. Lastly, remember that credentialing process also involves multiple forms submission, and this is the reason that physician data should always be updated.

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