Insurance credentialing refers to the process of applying to be included as an in-network provider with an insurance network. This means that when patients use your services and are represented by a certain insurance provider you know you can process their claim and be reimbursed by the insurance network.
Is Insurance Credentialing Hard?
Unfortunately, credentialing is a difficult process to go through. It’s time-consuming, takes a lot of work, and can be confusing, especially for new practices that are just getting set up. It’s important to go through the credentialing process as many patients will find a healthcare provider based on where their insurance is accepted.
It also signals to the patient that your practice is a legitimate healthcare provider and that they can trust you with their care, and their personal information. Failure to obtain proper credentials can result in insurance carriers not reimbursing your office for procedures and services you have completed.
Credentialing isn’t just an administrative procedure. It actually prevents the risk of medical errors from occurring.
What is the difference between credentialing and contracting?
Insurance credentialing is when insurance companies verify your practice’s background. They will look at your education, training and your professional experience to make sure that your practice meets their requirements for becoming an in-network provider.
The contracting phase is when the insurance provider issues a participating provider agreement. In this agreement, they will define the terms of participating to receive in-network reimbursements for your claims.
At this stage, your practice should review the contract, reimbursement rates, and the details and responsibilities you will have if you get accepted into the network. If you are happy with the contract, your practice can sign up to the in-house network. It is a good idea to review your contract, and after a year, it is a good idea to evaluate which networks the volume of your patients are with and consider renegotiating reimbursement rates. It is possible to negotiate contracts once you are in a network with an insurance carrier.
How long does it take to get credentialed with insurance companies?
Credentialing times can vary from network to network. A standard credentialing process can typically take 2-6 hours to complete an application and anywhere between 90 to 120 days to be accepted. Once accepted as an in-network provider, your practice will be listed in the insurance carriers’ directory.
As medical credentialing is a complex process, it pays to allow time for this to happen. The benefits to becoming an in-network provider with insurance carriers are worth the effort. The application process is lengthy and your practice may have to fill out forms that are up to 300 pages long. One way to speed up the process is to hire an outsourced revenue management provider.
Bikham Healthcare has years of experience in credentialing and can help practices complete their applications twice as fast for Medicare, Medicaid, Aetna, Cigna, Anthem, TRICARE and many other providers.
Bikham can help your practice with network research, application filing, application follow up, appeals for closed panels, out of network enrolments, demographic changes, annual credentialing maintenance, and contract negotiations.
How long does it take to get credentialed with CAQH?
CAQH stands for Council for Affordable Quality Healthcare. CAQH is an online database for credentialing data. Practices can import their credentialing information for insurance networks to access. Data includes demographics, education and training, malpractice history, work history and other relevant information. Having electronic access to this information reduces the time it takes and the amount of paperwork needed to enrol with a payer network.
It takes a couple of hours to complete the CAQH application, although ongoing maintenance is required to keep data up to date.
CAQH aims to streamline the process and make it faster for insurance networks to accept practices as in-network providers.
Who needs CAQH credentialing?
All providers are required to complete a CAQH application and keep it up to date. CAQH credentialing is mandatory in all states except for Idaho, Hawaii, Minnesota, and Washington, as there are alternatives that operate in those locations.
Keeping up to date PECOS and CAQH profiles is a necessity and unfortunately is not a set and forget process. A lot of work goes into keeping information accurate and up to date. This is another reason why outsourcing to an insurance credentialing and revenue management cycle vendor is an excellent idea.
Bikham’s Insurance Credentialing Services
At Bikham Healthcare, we can maintain and keep your CAQH profiles up to date, making sure that all information is accurately updated and compliant. Bikham offers the complete cycle of credentialing services for single practitioners, laboratories, group practices, and nursing facilities.
By outsourcing these services, Bikham will reduce the time and money you have to spend making sure your applications are filed correctly, and all documentation is in order. They also take care of the filing, follow-up, appeals and yearly maintenance that comes with credentialing. From start to finish, they can walk you through each step of getting approved with an insurance payer.