All you need to know about the Addiction Treatment Credentialing Process

Addiction Treatment Credentialing

Addiction Treatment Credentialing

With medical practices striving to combat the substance abuse crisis, it is now necessary for them to get credentialed to obtain reimbursement for addiction treatment-related procedures. The addiction fighting workforce involves about 100,000 healthcare professionals including counselors and educators. They help in the treatment, recovery, and support of those suffering from substance abuse disorders.

With a majority of patients falling under the federal insurance programs like Medicare and Medicaid, failing to get credentialed with these federal programs may render a medical practice ineligible to offer treatment and recovery services. It is important to note that private and group practices are not eligible to offer addiction treatment services.

In case you are curious about the process of addiction treatment credentialing, the following information might help.

What is Addiction Treatment Credentialing?

General Credentialing is a process in which the background, legitimacy, and qualifications that medical practitioners need to become licensed are assessed. This concept is simple and is designed to protect ailing individuals from being exploited by fraudulent practices.

By getting credentialed, providers have the license to legally serve patients and get paid for the services that they perform.

The need for Addiction Treatment Credentialing

Ever-high cases of Substance Abuse

The crisis of addiction that our country is facing today is no less than a nightmare. According to a report, around 70,000 Americans lost their lives due to drug overdose in 2017 alone. The major drugs that were abused were opioids, heroin, and illicitly manufactured fentanyl.

The death rate due to substance abuse saw an increase from 6.2 per 100,000 people in 2000 to 14.2 per 100,000 people. This number signals a strong demand for medical practitioners with the required skills and qualifications to help curb issues related to this disorder.

Consistent Work

One of the major benefits of credentialing is getting into an insurance panel and being called an in-network provider which allows for dealing with billing, reports, and deliverables consistently. The kind of uniformity that this system offers helps healthcare practices make crucial decisions more effectively.

Better Customer Support

Being in-network with insurance providers allows medical practitioners a chance to socialize and build valuable relationships. This helps in faster claim resolution and solutions related to claim issues including pre-authorization, re-authorization and claims information online. All of these factors help medical practices offer better customer support to their customers.

The Process

The process of Addiction Treatment Credentialing is time-consuming and complex. The complete process can take anywhere between 90-120 days. Therefore, it is suggested that credentialing be started as soon as possible. Medical providers may also be required to make 45-minute calls every day to follow up with insurances.

Medical providers might find the process cumbersome to execute with precision. Hence, it is a prudent exercise to seek help from a third-party service provider like Bikham to get the job done on your behalf.

Step By Step Process

1. Applying to obtain NPI (National Provider Identifier). These applications may require information like SSN, BCBA certificate number, Taxonomy Code or BA license number. Acquiring an NPI can take up to one or two days.

2. Becoming a member of the Council for Affordable Quality Healthcare (popularly known as CAQH). It requires information like employment history, references, resume or CV, W9 form, BCBA certificates, educational history, and some other information about your medical practice.

The information submitted along with the application is verified by insurance companies as soon as they receive it.

Increase your patient numbers

Medical practices need to be privy of plans and terms of insurance coverage offered under plans by insurance providers. No matter how noble your intentions are, there’s no point in starting a de-addiction practice without the necessary credentialing requirements.

Addiction treatment insurance credentialing is essential for medical practices to continue seeing new patients and accept payments from insurance providers justifying their services. The process of credentialing can be tedious, but a partner like Bikham can help alleviate the pain points in running a successful medical practice.

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