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Want to treat more patients and improve your practice? Joining insurance panels is a great way to expand your services and make them accessible to more people by partnering with well-known insurance companies.
Not sure where to start with medical insurance paneling? Don’t worry, we’re here to guide you through the process. By understanding the credentialing panel’s requirements and submitting the necessary paperwork, you’ll ensure you meet the standards of each insurance company.
Follow these easy steps, and let’s help your practice grow!
Overview: Insurance Paneling In Healthcare
An insurance panel is a list of healthcare providers that a health insurance company has contracted with to deliver medical services to its members at pre-negotiated rates. When a healthcare provider, like a therapist or counselor, joins an insurance panel, they become an in-network provider, agreeing to accept the insurer’s rates. This partnership allows providers to access a broader patient base, as patients often face lower out-of-pocket costs for in-network services compared to out-of-network ones.
In-network providers have agreed to the insurer’s terms, while out-of-network providers have not joined any insurance panels and can set their own rates. Although out-of-network providers can offer services to insured patients, those patients typically pay upfront and seek reimbursement from their insurance company at the out-of-network rate, meaning providers don’t receive direct payment from the insurer. Understanding these dynamics is crucial for healthcare professionals looking to expand their practice and reach more patients.
Here’s a step-by-step process on how healthcare providers can get paneled with insurance companies:
Step 1: Preparing Your Documents
Gathering the right information and documentation is essential before you apply for insurance paneling. Being well-organized will help you avoid any delays or rejections in getting your application approved.
Which may include your:
- Licensure information
- Practice address
- NPI number
- Resume
- Proof of malpractice insurance
- Taxonomy code (if you plan to bill Medicare/Medicaid)
- Proof of liability insurance from your landlord (if you rent)
- Advanced training or credentialing paperwork (if you have any)
Step 2: Steps to Fill Out Your CAQH Application
Many organizations rely on the Council for Affordable Quality Healthcare (CAQH) for their credentialing needs, so it’s important to be prepared before you start the process. Ensure your resume is flawless, with employment dates formatted as MM/YYYY and no gaps. Apply through the CAQH enrollment hub, which can create additional delays since it requires clerical input to process.
Once you’ve submitted your application, keep track of your information, as you’ll need to re-attest to it two to four times a year. Respond promptly to any requests for updates, as failure to do so could result in insurance companies refusing to pay your claims. Being proactive in this process can make a significant difference in your success!
Step 3: Finding the Right Insurance Providers
Once you’ve organized your documents, it’s time to start exploring different insurance companies. Keep in mind that each company has its unique rules and payment rates, and some may require years of experience before signing insurance paneling agreements.
As you begin your search, here are some important factors to consider:
➤ Network Size
Choose insurers with extensive coverage networks in your area, such as UnitedHealthcare, Aetna, and Blue Cross Blue Shield, to reach more potential patients.
➤ Reimbursement Rates
Compare reimbursement rates for your typical procedures across different insurers. Higher rates mean better revenue per patient visit, so obtain fee plans to help with your decision.
➤ Experience Requirements
Some insurers require 1-2 years of practice experience. Look for companies with less strict experience criteria to broaden your options.
➤ Credentialing Timeline
The insurance paneling process can take 3 to 6 months. Opt for insurers like Cigna and Humana that offer quicker credentialing to start serving patients sooner.
➤ Payment Reliability
Research online reviews and consult colleagues to ensure insurance companies pay claims promptly. Timely payments are crucial for maintaining steady cash flow.
➤ Plan Types
Identify dominant plan types in your area, such as PPOs or HMOs, and focus on insurers that offer those plans to connect with more patients.
➤ Value-Based Care Initiatives
Investigate each insurer’s involvement in value-based care models, like ACOs or PCMHs, as these can impact care delivery and reimbursement.
➤ Administrative Support
Seek insurers that provide helpful tools, like online portals and electronic claims filing, as this can streamline your administrative processes.
Step 4: Submitting Your Application for Credentialing
To kick off the credentialing and paneling process, healthcare professionals must submit individual applications to each insurance company they wish to partner with. Once you send in your application through CAQH, the insurance company will provide you with a unique application number. This number is beneficial as it enables you to monitor your application’s status during the credentialing journey.
The CAQH ProView application serves as a centralized platform for your professional and practice information. This feature eliminates the need for multiple applications to different insurance companies, saving you precious time. Additionally, it reduces the administrative burden and ensures consistency in the information you share with payers.
Step 4: Follow Up After Application
After submitting your insurance paneling application, it’s important to follow up promptly. Most insurance companies will inform you about the expected timeline for credentialing, typically ranging from 4 to 6 weeks. It’s a good idea to check in with the provider relations team around the four-week mark to inquire about the status of your application.
When you follow up, have your NPI number, Tax ID number, and application reference number handy. Confirm that all parts of your application, including licenses, certificates, liability insurance, and your DEA certificate, were received in full. If you find that your application is still in progress, reach out again after six weeks. Staying proactive shows your eagerness to join their network. If your application is denied, request a written explanation for the rejection. Common issues like insufficient malpractice insurance or Medicare eligibility can often be resolved, allowing you to reapply successfully.
Step 5: A Close Look at Approval Terms
When you receive approval from insurance companies to join their provider network, it’s crucial to thoroughly review the terms and conditions before signing any contracts. Doing so can help you avoid complications down the road.
Here are some essential areas to examine:
- Provider Portal Access: Lastly, confirm that you have access to the portals that enable you to verify patient eligibility, claim status, authorization requirements, and more.
- Reimbursement Rates: It’s important to assess the fee schedules pertinent to your specialty to ensure the reimbursement rates are equitable. Keep a keen eye on the relative value units (RVUs) tied to the CPT codes you commonly bill.
- Billing and Coding: Understanding the billing and coding standards is vital. Make sure you’re familiar with the accepted CPT and ICD diagnostic codes and the submission process, including formats and deadlines.
- Authorization Requirements: Take note of any necessary permissions, referrals, or documentation you must acquire before providing specific medical services or procedures.
- Contract Exclusions: Be alert to any exclusions that may apply to medical services, procedures, diagnoses, or types of providers you plan to offer.
- Appeals Process: Familiarizing yourself with the procedures and timelines for appealing claims and addressing denials is essential.
- Penalties: Reviewing any potential fines or fees for failing to comply with billing rules or contract terms is imperative.
Must-Know Tips for Healthcare Providers
Here are some important tips to help you get on insurance companies’ panels and avoid any issues.
➤ Get Board Certified
Board certification is crucial for acceptance by major health insurance companies, demonstrating your training and ethical standards. After residency, take the exam in your specialty to show your expertise.
➤ Consider Intern Policies
Review intern policies carefully, as unlicensed interns usually can’t bill independently. Check state laws and each insurer’s policies to ensure compliance.
➤ Know the Required Time
Understand the approval timelines for each insurer to follow up effectively. This demonstrates your professionalism and commitment.
➤ Be Honest About Previous Disciplinary Actions
Disclose any past disciplinary actions during your application process. Transparency builds trust and may prevent disqualification.
➤ Know If You Are a New Licensee
Seek insurers that accept new practitioners. Starting with Medicaid or Medicare can help you gain experience and grow your patient base.
➤ Stay Informed
Stay updated on insurers’ rules and guidelines to adapt your practice and maintain strong relationships. Regularly read communications and engage with industry contacts.
Advantages Of Getting Paneled With Insurance Companies
Joining insurance companies brings significant advantages for healthcare providers, primarily by increasing patient access to your practice.
✦ Increased Patient Volume
Aligning with various insurance networks enables more patients to seek care at your office, enhancing your practice’s visibility.
✦ Enhanced Revenue Potential
Having more patients accessing your services through different insurance plans allows you to potentially increase your earnings.
✦ Access to Affordable Care
Being in-network facilitates easier access for patients to receive a range of affordable medical services, especially those who might struggle to pay out-of-pocket.
✦ Strengthened Professional Reputation
Collaborating with reputable insurance firms boosts your credibility, demonstrating that your qualifications meet high industry standards.
After completing this, Tranquil MedSolutions can assist you in submitting your insurance claims electronically. This approach not only saves time and paper but also accelerates payments and minimizes the chance of errors. Plus, you can submit claims electronically even if you’re not in-network.
