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Time and again new practices invest countless hours and money focused on office space, equipment, software and staffing only to open their doors for business and find critical delays in getting sufficient assurance reimbursements. More often than not, the problem could've be allayed by addressing the assurance credentialing process early and wholly - creating the critical relationships with assurance carriers. Here are a few considerations to keep in mind as you address the assurance credentialing process.
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Timing - Start Early!
Plan on starting the assurance credentialing process early - at minimum allow at least six months before you see your first patient. Carriers will often take as much as 3-4 months to divulge documents and make a determination, even if all things is in order. If there are errors, missing facts or a interrogate about submitted documentation, any more weeks or even months can be added to the process. This six month allowance, starting from the time credentials are submitted, ordinarily gives sufficient time to address problems should they arise. If too slight time is granted before the institution opens, and you begin looking patients before assurance credentialing is complete, you are open to the risk of getting an "out of network" rate, reimbursements might be sent to the patient, or, worst case scenario, you may not get paid at all.
Identify Target Carriers
To define which insurances you might credential with, reconsider your institution location and outpatient demographics. Will a critical ration have Medicare or Medicaid? Is there a particular business or business in the area that employs a large portion of the surrounding population? A quick call to their human resources office to interrogate what insurances they currently offer employees (as well as potential changes the near future) can be a good indicator of the carriers you'll want to consider.
Also, check with colleagues, other providers, clinics and even larger hospitals in the area and ask who their most common payors are. interrogate about which payors are best to work with - who reimburses in a timely manner, which offer the largest enrollments, and which carriers might be at capacity with other providers in your specialty.
As you identify which assurance carriers might be most favorite in the area, make a list of the top 10 or 15. Then, think about what other providers are saying and pare that list down to the top 7 or 8. This will be your short list of where to go next. Don't go overboard and pick too many from the start - if nothing else, you'll run yourself ragged in retention up with the submissions.
Contact assurance Carriers
With your list of 7 or 8, prepare to spend at least an afternoon (or more) on the phone with the provider services offices of each of your target carriers.
One of your first questions might be to ask if they are accepting new practices in your specialty in your area. More often than not there's no problem here, but don't be discouraged if they say no - just keep fascinating down the list and prepare to check back with them later for an opening. (Just remember, if any carriers on your list indicate they are concluded to new providers, you might want to reassess your location before fascinating transmit - looking manifold carriers concluded to new practices in the same area is a strong indicator that there's a lot of competition in the neighborhood.)
If the carrier is receptive to new providers, make sure you get all pertinent facts about the process - i.e. Names, addresses, phone numbers, timing, required forms, and so on. Don't forget to ask about online submission too, as many carriers today allow you to furnish all facts online and mail in the supporting documentation.
**Remember that carriers won't start the assurance credentialing process until you've established a institution phone estimate and address (a Po Boxes are not acceptable). If you've established a institution address but haven't moved in yet, carriers can ordinarily send the forms to an alternate address, but you'll still have to identify the location to get things going.
Submitting Credentials
Now that you've completed your explore and identified which assurance carriers you're going to file with, you'll need to compile and submit all of your information. Most will generally wish you furnish the following:
While this can be a lot, there is some good news - since most carriers ask for the same information, once the first submission is complete, you can just transcribe all the details from one form to the next. You will also benefit enormously in the time to come by storing copies of these documents in a safe place. As your institution matures and you seek to credential with other insurances, you'll have this same repository of facts easily available.
Once you've completed the application, don't forget to duplicate check everything. In fact triple check it and have someone else look over it as well. Don't expect carriers to exact an inescapable mistake for you - it's not their responsibility, and, frankly, they just won't. The importance of duplicate and triple checking cannot be stressed sufficient as the entire process can be help up by a month or more from the slightest mistake.
Finally, after your facts has been submitted, allow an accepted estimate of time (1-2 weeks for mailed submissions) and succeed up with the provider services office to confirm receipt. If you were able to gather a experience name in your early explore call them directly. Once receipt is confirmed don't hesitate to succeed up again in say, 3-4 weeks to see if they've reviewed it yet or if they found any problems. If everything's on track, plan on checking back in other 3-4 weeks until the process is complete. This can save a lot of turnaround time if you can learn over the phone there was some sort of hold up. As alluded to above, expect this part of the process to take any months - credentialing offices are often centralized and may be reviewing hundreds of submissions for many different areas at any given time. If there's no movement after any months, you reconsider stepping up your calls to a weekly basis.
Hopefully your hard work and phone calls has paid off and you've made it through the assurance credentialing process in just a few short months with your traditional list of 7 or 8 carriers. If you're up for the challenge yet again, reconsider going back to your longer list of 10-15 and start the process all over again with the remaining carriers.
A few shortcuts
Here are a incorporate of shortcuts to credentialing not mentioned above.
Hire expert assistance: There are many different organizations that can help with the assurance credentialing process. If you've contracted with a institution supervision business this process is often covered already. If you're inspecting a medical billing business to administrate your assurance and outpatient billing they precisely should have the experience with carriers to furnish at least some guidance, if not administrate the process for you. Also, there are a few expert assurance credentialing associates that specialize in this process for new practices but they can often come at a high price.
Universal Credentialing DataSource: The Council for Affordable ability Healthcare has industrialized an online assistance intended to eliminate the need for manifold assurance credentialing submissions. In short, you complete one form for all of their participating assurance carriers and you authorize who will receive your information. The Caqh Universal Credentialing DataSource is located at: http://www.caqh.org/
Summary
The assurance credentialing process is critical to getting your institution off to a good start - and ensuring a quicker transition to profitability. While it can be time consuming, an early start will give you the opportunity to address problems should they arise. Just be outpatient and keep these tips in mind and you'll get through it:
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