Credentialing Services Process Improvement for Healthcare Providers
Methods to Improve the Medical Billing and Credentialing Process for Healthcare Providers
Setting up the healthcare business has many challenges, and the most critical one is to find Credentialing Services for insurance enrollment and contracting for healthcare providers. If you are setting up a healthcare business, you need to start the insurance enrollment and credentialing process as soon as possible to avoid any issues in payments. Whether you are beginning your practice or adding a new doctor to your established healthcare group, it is essential to ensure all your doctor’s individual NPIs are linked with your group NPI (Type-2 NP) in the insurance records. It would be best if you recognized the significance of the credentialing process to avoid problems with claim denials which ultimately would result in decreased cash flow. When you are not ready to accept all insurances, that will result in fewer appointments scheduled, which will negatively impact claims billed and paid.
Insurance Credentialing Services to Start Process
Having an insurance credentialing services on board to act as credentialing coordinator helps to keep track of application submissions, send required documents, keeping records of deadlines and expirations for all insurance carriers. Regardless of whether the credentialing tasks handle in-house or outsourced to a third party, these tasks are always necessary to run to ensure you are getting paid continuously by the insurance plans. Outsourced insurance credentialing services have a process well designed to send timely reminders, calling the credentialing department of insurance to provide their required documents which ensures that credentialing status will expire for any insurance carrier. As a result, reimbursement requests for the claims submitted will not deny, and you will be paid faster.
Plan Credentialing Application Submission With Spare Time
Despite the fact that the credentialing process “should” take only 90 to 120 days, actual practices allow for up to 150 days or more if there would be any further complications. The process of insurance credentialing with different payers would require a different timeframe based on each insurance requirement, whether it is a government insurance plan, commercial, or an advantage plan. The time of taking providers in their network varies from one organization to the next. Assume that the whole process of obtaining credentials until getting the network contract will take 150 days, and consider yourself fortunate if it takes fewer days.
Participating in the CAQH Credentialing Solution Suite:
The Coalition for Affordable Quality Healthcare (CAQH) standard credentialing program is gaining popularity among payers and will adopt by an increasing number of them. When physicians consistently update and attest their information with the CAQH Enrollment Hub, the credentialing and re-credentialing processes go more smoothly for everyone involved. This is one reason why interfacing with this program is so valuable.
New Provider Joining Healthcare Business to be Scheduled for Credentialing Paperwork
After making an offer of employment to a healthcare physician, as soon as they accept the offer, you need to immediately request their academic credentials, individual NPI, and other necessary information to start the credentialing process immediately. The best practice in the healthcare business to ensure you are ready before going live is to submit paperwork to your Credentialing Services Company at the beginning of a new physician’s employment. Starting the application earlier gives you more flexibility, and you will be able to designate the start date in the future date of a new physician’s employment instead of requesting the effective date in the past, which in some cases is denied by the insurance company if it’s too old from the date of Credentialing Application submission. Once you set the contract effective date, there will be fewer chances of getting your claims denials, and you will be able to work on Denial Management in case things go south effectively.
Credentialing Services Advantage for Future
Developing a credentialing procedure may be challenging when you are working in-house. If you have a Medical Billing Company standing by your side to help you with Credentialing Services, that can help you in the longer run. When you hire an Outsourced Credentialing Services Company to handle the process of granting credentials ready with all insurance companies, you buy some time to educate your newly joining healthcare physicians for the clinical workflow. Your Medical Billing Company working on your credentialing application can request the necessary forms to be signed and documentation to get things started to let you know to improve other business indicators. Running a multi-physician healthcare clinic or the medical group will require constant efforts to be made to ensure that practice is credentialed, linked, and all mandatory information is updated in the insurance system; you have higher chances of succeeding if the credentialing process is being handled by an Outsourced Medical Billing Company with the required expertise in Credentialing Services. Having a Credentialing Expert team standing by your side with a well-designed workflow would be of tremendous advantage to your healthcare practice.
Physician Credentialing Demographics and Keeping them Up to Date
No matter if your Credentialing process was handled by an Outsourced RCM Solutions Provider or by an in-house Credentialing Coordinator, be sure that your credentialing demographics in the insurance system are p to date and accurate. This accuracy of healthcare provider’s information in the insurance system is not limited to the group information (healthcare practice); you also need to ensure that the accurate contact information for each physician in your practice is updated in the insurance system. When there is no direct communication between the parties involved, resolving issues involving initial credentialing or re-credentialing can take significantly more time than normal. The process of obtaining credentials also requires completing several forms to be signed and submitted, and maintaining open lines of communication is essential throughout.
Credentialing Services for Healthcare Providers
iCareBilling provides insurance enrollment and credentialing services to ensure you can buy more time to focus on improving your healthcare clinic workflow, and patient experiences. If you need help, contact iCareBilling Customer Service today and find out how we can help.
