Whether you’re a private practice or larger healthcare facility, insurance credentialing is the first and most crucial step when implementing or optimizing your revenue cycle . Yet, even when you know with which insurance companies you want to participate, getting credentialled is a time-consuming, expensive, and often frustrating process. That’s why many healthcare organizations often outsource this crucial step.
In today’s healthcare marketplace, the ability to accept a healthy variety of insurance plans is essential to your practice’s success. Provider insurance credentialing, also called provider insurance enrollment, is a process that health plans/payers use so that you can apply for inclusion in their provider networks/panels. If you wish to bill an insurance company as an in-network provider, you must undergo the credentialing and contracting processes.
The insurance company you’re applying to will verify that you meet their requirements so that you can serve as an in-network provider on their panel. Requirements will include your level of education, training, professional experience, and other related criteria.
Once your practice or organization is credentialed with an insurance company, you can then bill that specific payer directly. Also, many insurance companies offer providers other benefits, such as:
- Preferential reimbursement rates.
- Inclusion in their web-based directories so patients can locate you as a participating provider for your specialty.
- Provider portal access for self-serve options such as prior authorization and claims submission, as well as patient insurance verification.
- EFT (Electronic Fund Transfer) enrollment for faster claims payment receipt.
On average, each insurance application takes about 20 hours of manual labor to fully complete. Many provider offices have multiple providers within that group, who each accept anywhere from 6-12+ health plans. If you do the math, it becomes easy to understand why more and more provider groups are turning to outsourcing this entire medical billing function.
Bikham Healthcare has built a cost-savings calculator to help you understand the financial value of outsourcing this critical function: Bikham Calculator.