The Ins and Outs of Insurance Credentialing and Contracting for New Providers
Beginning your medical practice is thrilling, yet it entails vital administrative tasks for a smooth and successful launch. Among these tasks, insurance credentialing and contracting are often overlooked and underestimated. In this blog post, we’ll walk you through the entire process and highlight the importance of starting credentialing and contracting for new providers early in establishing your practice.
Why Start Credentialing Early?
Credentialing and contracting with insurance companies can be time-consuming, taking three to six months to complete. However, if you start early, you can run the credentialing process simultaneously while handling other practice setup tasks. This proactive approach will help you avoid delays in opening your practice and ensure you can start seeing patients and generating income as soon as possible.
Engage the Services of a Credentialing Specialist
Navigating the credentialing and contracting for new providers can be overwhelming, especially if you are new to it. Therefore, it is wise to seek the assistance of a credentialing specialist in your area. Although there may be associated costs, the expertise and experience of these specialists are well worth the investment. They understand the intricacies of dealing with different insurance companies, know the required documentation and can communicate efficiently with payers on your behalf.
Check and Update Your CAQH Profile
The first step in credentialing is ensuring you have a current and accurate CAQH (Council for Affordable Quality Healthcare) profile. This profile contains your essential information, such as demographics, education, professional references, licenses, and DEA numbers. Many insurance companies use this profile as the foundation of their credentialing application, so maintaining it diligently is crucial.
Obtain Your NPI Numbers
Your NPI (National Provider Identification) numbers are vital identifiers for healthcare providers. NPI one is your identifier, while NPI two is for group practices. Apply for your NPI two even if you don’t plan to expand or bring on other providers immediately. Being prepared will save time and effort down the road.
Gather Necessary Documents
To complete the credentialing application, you must provide documents supporting your license, DEA registration, and evidence of the last two years of continuing education. Work with your credentialing specialist to ensure that all the required documents are ready and accurate.
Choose the Insurers You Want to Participate With
Identify and select the insurance companies you wish to be in-network with as a participating provider. Your credentialing specialist will help you determine the most common insurers in your area. It’s also important to apply to government insurance plans (e.g., Medicare, Medicaid), but note that their credentialing process might take longer.
Review and Negotiate Contracts
Once the insurers have reviewed your application, they will send you a contract outlining the terms and reimbursement rates. Take the time to thoroughly review the contract, highlight any unclear terms, and negotiate fees, especially if they are not up to the standard Medicare reimbursement rates. Highlight any distinctive services or factors that differentiate you from other regional providers during this opportunity.
Insurance credentialing and contracting for new providers may seem daunting, but they can be streamlined and efficient with the right approach and a reliable credentialing specialist. Start early, stay organized, and negotiate favorable contract terms to ensure your practice is financially sustainable and ready to deliver quality patient care from day one. Remember, the time and effort spent on credentialing will yield long-term benefits, fostering the growth of your medical practice.