How do I get on insurance panels?
This is definitely the million dollar question for healthcare providers of all types, from physicians and nurses to psychologists and counselors. These days, everyone is looking for the most cost-effective and stress-free way to get on the panels that will help their practice grow.
You’ve heard the Buzz words: Medical Credentialing, Insurance Panels, CAQH, PPO vs HMO, and Medicare vs. Medicade.
You’ve also heard other doctors, psychologists, and nurses talk about accepting insurance–the pros and the cons. The worst and best case scenarios.
On this website we’re going to teach you tips and tricks that can help you get on insurance panels. In addition, if you’re looking for a company to do credentialing for you–well, we have you covered there too.
Why is it important to get on insurance panels?
If you’re a healthcare provider, you know firsthand how essential credentialing with insurance companies is. Getting on panels is becoming more and more vital now that everyone has insurance and wants to use it.
Chiropractors, counselors and even massage therapists are switching from “cash-only” places to practices that accept a wide range of insurance. You don’t want to be left behind!
What does the process of credentialing involve?
Put bluntly, getting credentialed is an extremely tedious process. You have to retrieve and complete multiple insurance applications, submit them to the insurance companies and then correspond with them as you wait for everything to be approved.
If done correctly, the entire process may take 90-120 days (3-4 months), but that is if everything has gone smoothly (which is horrendously rare). Providers typically find themselves having to resubmit applications, face rejections and leave a plethora of voicemails with auto attendants.
Also, with more practices trying to get on the same insurance panels, you may come be told that the panel is not accepting new providers. You must then work towards appealing to the company to be an exception.
To sum up, the medical credentialing process is not something people generally look forward to. But there are ways for you to make this process easier.
Before you take the time to start the process with an insurance company, it’s vital to research all of the insurance companies in your first in order to find out who will be the best fit for your practice. You will also learn about how the process differs for each company and what you can expect from applying.
Complete your CAQH Profile
The Council for Affordable Quality Healthcare (CAQH), is usually needed in tandem with an insurance company’s application to complete one’s medical credentialing. Large insurance companies, like Blue Cross Blue Shield and Aetna, use CAQH as a significant part of their application process.
That said, there are a lot of facts you need to know about CAQH:
1) It’s invitation-only.
You can’t just go on to the CAQH website and create a profile; you need to be invited by an insurance company! This is a delicate process that requires precision. First, you must submit your application to the insurance company. Then, you must call that company a few weeks later to make sure they received your application and have generated a CAQH number for you. Once you have that, you can now go to the CAQH website and fill out your application. It will then be sent to the insurance company so that they can use it approve your initial application.
2) Don’t fill out your CAQH on paper.
You’re offered the chance to fill out the CAQH application on paper instead of online, but you should never do this. The application is about 50 pages long and can only print correctly in color. Also, and more importantly, if you submit an application in paper, they have to convert your handwritten text to digital manually. As you can imagine, this never gets done. They will just lose your application and ask you to complete it online.
3) Make sure that your resume is perfect.
To avoid rejection, ensure that you’ve completed your resume according to the correct format. Your dates of employment and education must be in Month/Year format (10/2013).
Additionally, you need to make sure you have no gaps in your employment history, even if you were unemployment. Every gap needs to be accounted for. Otherwise, your profile will be rejected, and they will ask you to fill the gap, which means more of your time has been wasted.
4) Don’t forget your re-attestation.
Four times a year, you’ll receive an email from CAQH asking for you to “Re-attest” to the information in your profile. Failing to do so may cause major problems with your ability to accept insurance, since the insurance companies you are paneled with will know about your CAQH lapse. Re-attestation only takes a few minutes (if you can remember your provider number and password), so log in and get it taken care of as soon as you can.
How many hours should I expect to devote to an insurance panel?
Expect each insurance panel to take about 10 hours of focused labor for each insurance company you are seeking to be in network with. These hours include all of the time spent getting applications, filling them out, preparing your documentation and following up with the insurance companies. Though some applications are electronic, many must still be printed and filled out manually.
How often should I follow-up with the insurance companies?
Unfortunately, insurance companies are notorious for losing provider applications or failing to review them in a timely fashion, which can lead to your credentialing process going nowhere. If your application is stuck in this limbo for more than a few weeks, it will expire and be rejected by default, which means you have to start all over again.
That said, you should be following up with them regularly and often, ensuring that your application isn’t being ignored. Call them every time you fax, email or mail an application or documentation. From there, you should call the insurance companies at least once every 2 weeks to receive an update on the status of your applications.
How can I get help with credentialing?
Consider letting a professional credentialing service manage the hours necessary for getting your applications submitted and approved. It take the stress off of you, since you know that an experienced team will get it done quickly and efficiently. It also saves you money by getting you credentialed faster, allowing you to start receiving insurance sooner, rather than much later.
How long do I need to be licensed before I can get on insurance panels?
There is no “one right answer” to this question since every insurance company is different, especially according to where you’re located. In most cases, fully-licensed providers are able to get on most insurance panels. Intern-level and intermediate-level licensed professionals are not as likely, but there are some exceptions.
For example, UBH / United Healthcare prefer providers that have been fully licensed for 2 years. Other companies like Value Options are stricter, requiring at least 3 years. Fortunately, there are plenty of companies like Blue Cross Blue Shield, Aetna, Humana, Cigna and others that aren’t quite as strict.
What do I do if the panel I want to be on is closed?
Finding out that your dream panel is closed doesn’t mean you’re in a hopeless situation. More often than not, insurance companies are saying a given panel is closed when it’s actually restricted or limited.
From there, you can appeal to the insurance company by explaining why your panel should be credentialed with them. You can stress key benefits about your practice that may include:
1. You offer weekend appointments
2. Your area is underserved
3. Your office hours are extended
4. You offer therapy in a second language
5. You work with children
6. Your office is handicap-accessible
7. You’re affiliated with another practice or organization that refers clients to you, and they are credentialed.
8. You receive many clients that want to use this insurance with you.
And there are plenty of other convincing arguments you may have uniquely to your practice. Though no one has a 100% success rate with these types of appeals, providers are usually pleasantly surprised when insurance companies are persuaded.
It’s time to get started.
Getting on insurance panels is not easy and it takes a lot of time and patience. Still, with the right resources in place, you can make it happen, and it’s much wiser to do it now rather than later. With huge changes in healthcare coming in 2014, it’s more vital than ever to get a jump on this.
We Can Help.
Our full-service credentialing team at Thriveworks has the experience necessary to take this burden off of your shoulders. If you want to learn more about how we can help and what this process will entail, call us anytime 1-855-4-THRIVE (847483).
We can’t wait to learn about your practice and what we can do to get you on insurance panels!
How do you know so much about this process?
This website is actually owned and operated by Thriveworks, a full-service medical credentialing company that helps practices all over the country get on insurance panels every day. We know the industry inside and out, so you can contact us anytime (1-855-484-7483) about more ways we can help you complete the credentialing process.
Our process for getting practices like yours on insurance panels is built to make the process easier for you. Part of finding success in credentialing is matching you with the right insurance company. Our strategy for ensuring this starts with a simple application we send your way entitled the “master survey.” It covers some of the most basic questions related to your practice, such as your license number, expertise, and education.
Once we’ve gotten to know your practice, we research the area and determine which insurance companies would be best for you to be in network with. We can then begin the process of getting your credentialing applications completed, submitted, and put in front of the insurance company, updating you as we go. You can even view your progress on an online dashboard.
As you explore this website, you’ll find great tips and insights that will help you get you started if you want to complete the process alone. But if you’re interested in having us do the tedious work for you, so you have more time to focus on clients, give us a call and we can discuss your options.
You can call us anytime at 1-855-4-THRIVE (1-855-484-7483).