Credentialing and contracting are processes you must go through to participate with insurance networks and receive in-network reimbursement for your practice's medical care service. The process is known as provider enrollment.
There are too many manuals and varying procedures involved in the credentialing process for providers with payers, such as filling out applications, responding to payer questions, and following up to ensure the credentialing request is completed promptly and accurately.
Therefore, it is advisable to use enrolling and credentialing services to perform this tolling and time-consuming task. Credentialing services help keep your data up to date.
Provider credentialing is when an insurance carrier formally assesses a provider's qualifications, licenses, and competency to admit them into their payer network.
Provider credentialing is critical in improving your revenue cycle as it gives patients the ability to use their insurance cards to pay their medical bills. Provider enrollment enables you to get reimbursed by insurance companies for the healthcare service you provide.
Therefore, it is crucial that you get credentialed and enrolled with multiple insurance panels to enable access to a broader range of patients who can use their insurance plans to receive medical care in your practice.
Today, neglecting provider enrollment will weaken your competitive power as most prospective patients will instead employ the service of practices already enrolled with their insurance companies.
Credentialing with a payer can be a tedious, time-consuming process that involves sorting through many documents, providing an adequate response to the payer, and closely following up with the payer on the progress of your credentialing request.
The procedures process of getting involved with provider credentialing consists of the following steps :
To get your practice enrolled for the services you provide, provider enrollment services ensure that payers have the necessary data to process claims for the applications are processed speedily to avoid unnecessary delays in payments.
And if there are any potential administrative issues, they resolve them speedily, so it doesn't affect your reimbursements.
In carrying out provider enrollment, the following steps are taken;
Provider credentialing and enrollment are simplified when you partner with a revenue cycle management partner who reviews and gathers documentation to determine the provider's participation in the health plan.
Credentialing and enrollment services designed to meet insurance plan requirements eliminate the headaches of tracking applications for credentialing and enrollment.