5 factors that influence the insurance credentialing process for group practices

Below are 5 factors that influence the insurance credentialing process for group practices.

1. Discretion

The first key to provider enrollment is to choose the most appropriate insurance companies and panels to target. Not all insurance companies are created equal; in fact, deciding which companies to partner with is an essential first step for your group practice. Insurance credentialing takes up to 180 days and requires time-consuming preparation for each application.

The first key to successful credentialing is choosing which insurance companies will benefit your practice and your patients the most. When choosing the companies to partner with it is important to know which insurance is popular in your area and which insurances cover mental health services.

Some large insurance companies to research and choose from include:

2. Determination

The new influx of applications for insurance credentialing has led to many insurance companies reach patient capacity within the panels and closing to applications. While some panels may be marked ‘full’ or ‘closed’ an application can still be submitted. Often these companies are being more selective in regards to which practices they wish to add. Overcoming these closed panels requires determination on your part!

If an insurance company has a closed or full panel it is worthwhile to look into submitting an appeal to the company to discuss reasons why your practice should be accepted. These panels are often the most beneficial for your practice and your patients, so it is worth the extra effort to contact and communicate with companies who have stopped accepting open applications.

3. Organization

There are a handful of documents that will be required to supplement an application to an insurance company for credentialing. Each insurance company requires different documents for each practitioner, including a current resume or CV, signed W-9, state license, Face Sheet of Insurance, diplomas of education, certifications, record of disciplinary action (with explanations), blank/voided check, tax ID letter from the IRS, and a business license to name a few.

The organization of these documents is a critical component to the application. When applying, it is important to compile a similar list of documents (including other applicable licenses) and have them readily available upon request from the insurance companies for each practitioner. The more organized your documents are, the faster the insurance company can process your application.

4. Resiliency

Insurance credentialing can be a long process, but it is essential when starting a new practice or growing an established one. There are a variety of obstacles that may arise throughout the application process—so resiliency is your key to success. If your application needs a revamp, improve it, and then apply again. If you missed crucial documents, track them down, and apply again. If an insurance panel is closed, keep an eye for it to open, and then apply again. If an insurance company isn’t getting back to you, call them again.

Getting credentialed is a long process, but it will be a dead end if you aren’t persistent. Don’t get discouraged if the companies you want aren’t moving as quickly as you’d like. Keep applying and your resiliency will pay off when you finally get credentialed.

5. Time Management

The credentialing process doesn’t happen overnight. The timeframe for a single application’s acceptance is roughly 50-180 business days, and that’s if the application was submitted correctly the first time. Often appealing for a closed panel or reapplying with correct information can lengthen the timeframe to 230 business days. A single application takes roughly 8-10 manpower hours. Group practices should have a holistic understanding of the time required for insurance credentialing in terms of the application’s needs and the waiting period before acceptance.

Getting your practice credentialed by multiple insurance companies can often be a pain, but with proper planning and resilience your practice will be able to offer services to a multitude of insured patients. If the process seems a bit overwhelming, never fear! Our team is ready to help you make provider enrollment easy!

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