How to Get Credentialed With Insurance Companies

how to get credentialed with insurance companies

 

Are you a healthcare provider wishing to accept insurance from any given carrier? Your first step is to go through the full credentialing process. Otherwise, you cannot submit claims on behalf of your patients who carry insurance with that company, and you may lose out on some revenue.

Below, PracticeForces, Florida’s top-rated medical billing services provider, explains how to get credentialed with insurance companies when you’re ready to become an in-network provider.

 

What Is Credentialing?

When an insurance plan “credentials” you as a healthcare provider, they verify that you have the necessary qualifications to seek reimbursement for the care you’re providing to their insured patients. Understandably, it can be a detailed and time-consuming process to confirm:

  • You are fully licensed
  • You have a good reputation
  • You manage the business side of your practice ethically and legally

The process can take ten hours or longer for every insurance plan that you want to join, which is why so many practices opt to work with an insurance credentialing consultant instead. An expert will handle the legwork for you, including submitting and following up on applications.

 

The Basics of the Credentialing Process

Whether or not you work with a consultant, how to get credentialed with insurance companies follows the same route. You or your consultant will pre-apply for the insurer to confirm your authority to practice medicine. If they’re happy, preparing the application packet for the credentialing verification organization begins.

This application packet usually includes documentation about you as the medical provider, your professional background, and your practice, such as:

  • Basic demographic and citizenship information
  • Proof of education, training, and licensing
  • Proof of board certification
  • A current resume
  • Disclosure about malpractice claims, sanctions, or disciplinary action
  • Peer references
  • Business license
  • Tax identification number
  • Proof of professional liability insurance

With this documentation in place, your chosen credential verification organization will conduct various background searches to confirm your information (you must sign a release to allow this). From start to finish, you can expect your credentialing with a commercial insurance plan to take 90 to 120 days. State credentialing takes up to 150 days, although Medicare and Medicaid might only take about 40 to 60 days.

 

The Contracting Phase

Have your patient’s insurance plans approved your credentialing application? The contracting phase starts, and you and the insurer iron out contract details and negotiate. For example, you may need to determine a fee schedule and reimbursement for advanced care planning.

Don’t Forget Your CAQH Application

Notably, many insurance companies also require credentialing applicants to submit a Council for Affordable Quality Healthcare Application. When you apply, you’ll receive a CAQH code and an invitation to complete a 50-page online application after the initial credentialing application.

Let PracticeForces Help You With Credentialing

Knowing how to get credentialed with insurance companies opens doors, but it does take some work and commitment. A team like PracticeForces could help your practice streamline these types of processes. Experienced credentialing professionals help with the following:

  • Support
  • Efficient processing
  • Improved compliance
  • Re-credentialing

Patient care takes enough of your time. Call PracticeForces today at (727) 499-0355 for help with billing, guidance, medical credentialing tips, and more.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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