Credentialing is a time-consuming process that involves checking documents such a physician’s state license, malpractice insurance, updated curriculum vitae, and a background check on the doctor’s financial and criminal past. Except in cases when the patient’s insurance covers benefits received outside of the patient’s network, late credentialing results in no reimbursement. As previously indicated, the cumbersome and slow insurance credentialing services procedure might quickly cost your firm money.
The credentialing procedure will go more quickly if you keep in mind the following points:
Begin early
When a new medical billing company joins your group practice, start getting ready to credential that provider as soon as possible. Gather all the data in advance, including professional references, proof of licensure, a current resume, information on malpractice, etc. State license, malpractice certificate, medical school certificate, and updated resume. The majority of business owners wait a few months. Stop waiting. Start early and prepare thoroughly because getting credentials usually doesn’t go as planned.
Application for Study Enrollment
By using pre-formatted payer forms, you may automate the credentialing process. Each payer has a different enrollment form and a different set of information needed to enrol a provider. When completing the initial application, you can pre-populate these info to speed up the process.
Submission to PECOS
The Center for Medicare and Medicaid Services sponsors the Provider Enrollment, Chain and Ownership System (PECOS), an electronic portal that supports the Medicare Provider and Supplier enrollment process by enabling registered users to securely and electronically submit and manage Medicare enrollment information. With software that enables direct data transmission between your system and the PECOS electronic portal, the PECOS submission automation. Direct communication will guarantee data correctness and expedited billing.
Team up with CAQH
A non-profit organization of health plans and trade organizations called CAQH (Council for Affordable Quality Health Care) develops and spearheads programs that have a beneficial economic impact. They also manage a global credentialing database for medical professionals. Today, a lot of health insurance plans are joining CAQH. You can access numerous plans at once by submitting only ONE application thanks to the direct database integration capability, which will save you time and greatly improve the effectiveness of your enrollment process.
In order to join a network that accepts the CAQH application, a provider must seek membership. The health plan starts the provider’s online account. After completing online applications, sends to CAQH along with a number of other supporting materials. Once the application completes, the provider’s information is accessible to any insurance company that accepts the CAQH application, speeding up the enrollment procedure. Normally, every 120 days, the provider data needs to be updated.
Obtain Additional References
Ask the supplier for more than just the standard three references, and make sure they give you along with everything else. Because many payers won’t even start the process until they have everything, including those references, lagging references may wind up slowing down the entire process. Most employers will want three references, but some may want five. Requesting more references up front can be helpful if one of the references proves to be problematic.
Automated Transactions by Payers
A healthcare practitioner typically collaborates with 25 payers. As we previously covered, in order to enroll for electronic funds transfers (EFT), electronic remittance advices (ERA), electronic data interchange for claims (EDI), and other typical provider-payer activities, each payer needs a specific set of forms, procedures, and data to be submitted. Providers must resubmit these forms if they make even small changes to their enrollment information.
Dealing with paper forms, fixing human mistakes, and finding out the status of enrollments traditionally takes up time. By using an automated payer transaction system to streamline your process, providers can complete a straightforward online form only once, and the enrollment information will be sent to all payers from an online list with just a single click.
Avoid Typical Mistakes
The process of obtaining credentials might occasionally be delayed by small mistakes that can be avoided. Knowing the typical errors so you can avoid them is one of the best things your practise can do.
Common errors include the following:
- Filling out forms incompletely
- Incorrect data entry
- Presenting an expired DEA license or number
- Work history gaps that haven’t been explained
- Giving an incomplete history of malpractice
- There are no references from professionals.
One of the finest solutions if you’re seeking for strategies to streamline the provider credentialing procedure in 2023 is to think about outsourcing your credentialing. Credentialing services are specialists at navigating this procedure, so by ensuring that everything is done correctly the first time, they may save you a lot of time. This procedure can be sped up by using a reputable provider, which makes the expense well worth it, especially if you need it done quickly.
Keep in mind that any delays in the credentialing procedure may have an adverse effect on the profitability of your firm. A supplier who lacks credentials is just a cost to the practice rather than a source of revenue. Although the process might be drawn out and tiresome, there are techniques to reduce delays and quicken it.
Start the process early, double-check that you have all the necessary information, watch out for typical mistakes, and maintain track of it with the payers. Consider outsourcing your credentialing if time is of the essence because it will ultimately result in time and cost savings.
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