Medical Billing And Credentialing: What You Need To Know

January 17, 2023

Whether you run a private practice or you're a hospital employee, you must be up-to-date on the latest credentialing requirements for each of your potential payers. With the various options your customers (patients) have today, it is in your best interest to meet the contracting requirements of as many relevant payers in the industry as possible.

As a healthcare provider, you are always looking to expand your patient base. The more patients you have, the more income you will make. It is simple: if you want to be attractive to more patient's you must ensure you gain the trust of many insurance companies in the healthcare industry. How do you do that? By meeting the credentialing requirements for those companies.

By doing this, you expand your patient base and decrease the need for these patients to seek out another provider.

This post will cover the credentialing process to be eligible for contracting and medical billing. 

Understanding Credentialing in Medical Billing

Providers must be credentialed to gain the trust of the countless insurance companies in today's marketplace. Credentialing is a prerequisite for contracting, so it could be crucial since many patients refuse to see doctors outside their insurer's networks.

Healthcare providers must continue expanding their patient base to continue staying in business. And the only way to do this is by meeting the strict requirements of insurance companies. 

After you meet the credentialing requirements, you can move into contracting and getting insurance reimbursements for the medical services you provide under the payer's network. The insurance providers refer to this process as credentialing and contracting. 

A part of the credentialing process, the insurance company, also conducts primary source verification, which involves verifying the provider's education, professional licensure, and other competencies. 

Credentialing typically takes 60 - 180 days. Thus, you need to avoid errors that could delay the process. However, Medicare uses its Provider Enrollment, Chain, and Ownership System, so they approve credentials for providers faster than commercial insurers, with an average approval time of 41 days.

Upon checking the provider's credentials, the insurance company extends a contract to include the provider in their network.

The Credentialing Process for Medical Billing

Applications are the first step to becoming in-network. Verify the application form you use with the insurance carrier is up-to-date before submitting it. Older versions can cause delays or even denial of your application.  

Complete all sections. If there are errors with your paperwork, it will delay your in-network status, so you will have to wait longer. If necessary, you must ensure that all supporting documents are attached to your application. 

Paperwork can sometimes go missing in transit. Hence, keep a copy of all credentials you submit.

Ensure you don't omit any information, including malpractice claims. During the credentialing process, insurance companies are thorough. All malpractice claims are maintained in the  National Practitioner Data Bank so, if the insurance company detects an omission of a malpractice claim, they will not contract with you. 

What Follows?

After filling out different forms, ensuring your documents are in order, and submitting your application, you need to follow up. Contact the insurance provider regarding the status of your application. Make sure they received all the materials you submitted. 

To summarize, this stage requires several phone calls, emails, and in some cases, personal visits until your application is approved. 

Avoid the Hassle of Self-credentialing 

Credentialing for medical billing can be a very time-consuming and complicated process. The insurance company requires an enormous amount of information and supporting documentation to verify everything on your application. Not to mention the challenge of following up after submitting your application.

You can save yourself the hassle of self-credentialing and the subsequent follow-up by letting the credentialing specialists at Float Care do the work for you. 

At Float Care, we streamline the credentialing process with our seamless, online solution, so you get results faster. Our credentialing platform allows for easy access to your information and real-time monitoring of application status. Let us do the heavy lifting while you focus on what really matters - your patients. 

Contact us today to discuss the process and how Float Care can assist with credentialing in your healthcare practice.

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