Self Credentialing for Small Practices
Credentialing is the process of enrolling your practice with insurance companies. Any claim will be successful only when your credentialing has been completed appropriately. Each state where you want to practice will require separate credentialing. When it comes to self credentialing for small practices, you will have to learn how to navigate insurance credentialing. It is important, as it affects the patients’ decisions to choose your practice. Many patients will prefer choosing practitioners whose services are covered by their insurance. Insurance credentialing is a time-consuming process. If you want to handle self credentialing, there are many things for you to know about. Here are four important things that matter the most.
1. Learn about the State’s Regulations
It is important to learn about the state’s specific requirements. Some states allow you to bill for services provided while the credentialing process is in progress. Some states will not allow this.
Some states hold reciprocity agreements with certain payors. This means if your practice is already credentialed with such a payor in one state, your credentialing in another state may be fast-tracked by that payor.
When it comes to self credentialing for small practices, it is important to keep up-to-date with any changes in laws at both state and federal levels. This can not only help avoid any difficulties due to changes in laws, but it can also prevent you from missing out on any benefits.
2. Learn about the Timelines
Credentialing approval can take time. The documentation can take two to four months for most insurance companies to process. It is important that your credentialing is complete before your completed services become billable. Keep the following points in mind:
- When entering a network for the first time, it may be possible to start credentialing the documentation before the full processing of the contract. This can help reduce the wait time.
- Find out how each insurance company assigns the dates. Some of them can set the effective date from the day of submission of the documentation.
- Consider a single case agreement to fill the gap when you are waiting for the approval of in-network status.
- Get new hires to submit credentialing paperwork the moment an offer of employment has been accepted.
Gather all the relevant information before you get started. The right knowledge can prevent delays. Typically, delays in application processing are caused due to incomplete, outdated, or missing information. Lack of complete information can cause the companies to pause the process.
3. Learn about Credentialing for Small Practices Documentation
All insurance companies have unique requirements for credentialing. For example, some will require you to submit proof of CPR training while others may require proof of RBT certification. A background check is required in all cases.
It is best to cover all these requirements during the hiring process. Some of the commonly required documentation for credentialing applications are as follows:
- CAQH: Problems with CAQH numbers are the most common causes of delays in the process. It is important to know how to navigate and maintain the CAQH profile. The application process can take two to three hours and require uploading certificates, licenses, and professional liability insurance. All this information along with education and work history should be handy before starting the application process.
- NPI: The process of applying for the National Provider Identification (NPI) number can take up to 30 minutes to complete.
- First Aid and CPR training
- State Licensure
- Resume covering information on dates of employment, explaining any work history gaps of more than three months, and addresses.
- Copy of certificates or transcripts.
Follow-through is an important part of credentialing. Once all the information has been submitted, it is important to conduct a follow-up on the application. This helps ensure that the application is in process. All insurance companies will not intimate the credentialing individual or provider about a pending request or missing paperwork.
Once the application has been submitted, you should not assume it will be automatically processed. Follow-up plays an important role in getting your application approved. The goal should be to get an effective date for billing. The intimation of the effective date will confirm that the credentialing process has been completed, leading to successful claims.
Credentialing for small practices is an intensive process that requires a lot from you. You will have to gather all the required information for the process. If applying to different states, it will be required to learn about the regulations for each one. It is also important that the license is updated. It is important to follow up, no matter the applications have been received. The key is to get an effective date. Once credentialing is complete, contracting is the next step. Once this step is complete, insurance companies can pay claims. Since it can be a time-consuming and intensive process, it is best to seek professional help. For more information feel free to contact Neolytix.
Frequently Asked Questions
What is involved in Self Credentialing for Small Practices?
The process of self credentialing for small practices involves filling out applications with insurance payers and submitting supporting documentation. The payers will verify your practice’s credentials to set you up for payments. There are different process paths for different insurance plans. The details of the process can vary based on the insurance company and your specialty.
What is NPI in Credentialing?
NPI refers to a 10-digit number that you must apply for to be able to bill insurance payers. Type I NPI is for individual healthcare providers and Type II NPI is for organizations and is also called Practice NPI. The NPI and your details attached to it will become your identifying factors with an insurance company. When applying for an NPI, you must submit accurate information related to your name, address, specialty, and type of group.
Which Insurance Payers Should My Practice Credential With?
An office manager or colleague in your area can provide you information on the insurance payers with the largest patient base in your region. If you are unable to find the desired information, it is recommended to contact us at Neolytix. Besides the major national plans, also consider the several Medicare Advantage Plans and managed Medicaid plans.