Getting credentialed with insurance companies is invaluable to a healthcare provider, allowing you to get reimbursed for services, obtain access to more patients, and build your practice. It can be a long and arduous process to get credentialed with insurance companies. How to get credentialed with insurance companies is a necessary hurdle in making sure your practice is on stable footing.

Credentialing provides assurance that you are qualified and meet the professional standards of insurance network health plans. Taking the right steps toward getting credentialed means you can build relationships with insurers and join insurance networks. The importance of becoming an in-network provider shouldn’t be overlooked.

Not only does it provide more visibility for your practice but also enables more access to high-quality care for your patients. Additionally, joining networks allows you to reach new markets and increase overall revenue from insurance payers. Making sure you have taken all steps necessary to become an in-network provider is key for any healthcare practitioner looking to establish or expand their practice.

How to Get Credentialed with Insurance Companies

As you no doubt know, anything having to do with health care, insurance, and paperwork can take a lot of time and some frustration. Here are a few important components of the credentialing process:

  1. Researching Insurance Companies
  2. Gathering Documents
  3. The CAQH Application
  4. Insurance Panels

Research Insurance Companies

Consider the type of health care you provide and the geographic area you serve, and determine which companies offer coverage in those areas. There may be certain plans that work well with the services you provide or more general plans for expanded practice. Aetna, Blue Cross, Blue Shield, and others all have their own plans, fee schedules, and processes.

Gather Documents

This includes primary source verification that you’re fully licensed, malpractice insurance documents, a list of your services, NPI number, tax ID number, practice address, office hours, and more. You will also need to include information about your residency, employment history, references, state and federal registration, and so on.

The CAQH Application

The Council for Affordable Quality Healthcare (CAQH) is an organization that offers a universal provider credentialing program, allowing healthcare providers to easily apply for credentials with multiple insurance plans. By having a CAQH provider identifier, you streamline your application process, as well as have access to multiple health plan contracts.

In order to obtain a CAQH profile ID, you must create an account on the CAQH website and follow the instructions provided there. This includes providing information such as your personal details, contact information, practice and specialty information, professional qualifications, and certifications.

Once this step is complete, you will be asked to submit documents such as a copy of your state license or any other required documentation that may be pertinent to your particular specialty. Upon successful completion of these steps, your CAQH Provider ID will be generated and you can begin applying for credentials with different insurance plans.

Insurance Panels

Once the credentialing application has been submitted, providers should reach out to their respective insurers to follow up and confirm receipt. Afterward, the insurer will review the credentials and compare them against their standards or requirements. If approved, providers can expect a notification confirming their status as in-network providers.

Finally, once a provider has been credentialed with an insurer, they are expected to adhere to any policies associated with participation in that particular network including but not limited to timely filing deadlines and other administrative tasks such as re-credentialing.

All told, the process can take months. But by following the above steps, healthcare providers can become credentialed with insurance companies and begin providing a variety of services to their patients. Doing so will help reduce out-of-pocket costs for both patient and provider while allowing them to continue offering quality care.

Credentialing doesn’t end here though, providers must also remain informed of any updates in guidelines or regulations from insurers as well as changes to reimbursement rates and policies. This ongoing effort allows providers to ensure they are meeting all requirements when interacting with payers on behalf of themselves and their patients alike.

How To Get Credentialed With Insurance Companies The Right Way

With the right preparation and attention to detail, providers can successfully navigate the process of becoming an in-network provider with virtually any insurer. This ultimately leads to improved care delivery, higher patient satisfaction, and healthcare outcomes, as well as greater financial stability for the provider.

Healthcare providers can also join professional networks or health services organizations that offer practice management tools and services such as credentialing assistance. These organizations often provide resources like updated forms and applications for each insurer as well as assistance with tracking submissions to ensure the completion of all necessary steps of the enrollment process.

Credentialing is a complex and time-consuming process, but with the right resources and support it can be completed in an efficient manner. It’s important for providers to understand the ins and outs of the process so they can maximize their efforts and become successful in-network providers.

Work With Insurance Credentialing Experts

Are you a healthcare provider searching for credentialing services? MBA Medical can help. With our expertise and 30 years of experience working with medical providers, you can be certain that we’ll make all the calls, submit all the forms, speak with all interested parties, and handle all the details to ensure that the process is completed quickly and efficiently.

We’re proud of our ability to ensure fair representation between practitioners and insurance companies, so you know that your best interests will be taken into consideration every step of the way. Feel free to reach out and discover how we can assist in making sure the credentialing process is successful for you!