Provider Credentialing is indispensable for any Medical Practice/Group. Delay and missed Physician Credentialing directly affect the financial aspect of the Provider and the practice. Employing Credentialed Providers also sets your standard high, increasing your integrity and making your practice the first choice for patient care. Let us look in detail, how Provider Credentialing can help the growth of your business financially.
Increased Patients Through Insurance Referrals
Credentialing with as many insurances as possible will fetch more referrals thereby increasing our reach and daily patient visit evidently. Credentialing is all about verifying the Provider Certification, license and malpractice history. Hence with Credentialed Physician on board patients reliability can be gained as Provider Credentialing assures them a safe and secure procedure as verified by their payor. When patient visits are increased it directly increases the revenue flow.
Provider Credentialing Process
A provider can apply for credentialing with the Insurance Company of his choice or as requested by his employer. Below are the process involved in Provider Credentialing:
- Check out if the Insurance is accepting new applications for Credentialing
- Complete the application with all mandatory supporting documents
- Ensure correctness and completeness in the details and documents provider
- Send across the completed application to the Insurance Company.
- Follow up regularly to know the status of your privileges.
Checklist For Provider Credentialing
While the above process of Provider Credentialing may sound as easy as said, it should be understood the process can be time-consuming and cumbersome and any mismatch or error in the details provided can lead to unnecessary delays in the process affecting practice and reimbursement.
- Filled in application
- Copy of Medical graduating Certificates
- Copy of State Licensures
- National Provider Identification Number(NPI)
- Social Security Number (SSN)
- Copy of Driving License
- Update CV with Personal details and Work History
- Proof for gap in work history
- Incident of Malpractice if any with current status
- Malpractice Insurance Coverage details
- CAQH and NPPES details
- W9 form
Payor Contracting
After post successful process of Provider Credentialing, the provider can get in-network with the insurance. This ensures the provider has more privileges compared to an out-of-network provider. In-network providers are required to adapt to the payer’s reimbursement rates and any additional plans if available. However, the provider is benefited by the increased number of patient referrals.
Prepare Ahead
Provider Credentialing is a time-consuming process and it is observed that it may take around 90 to 180 days, while trained and experienced staff can work towards a faster credentialing process. It is always good practice to ensure you are prepared well beforehand if you are expecting any of the below which definitely requires you to avail credentialing process.
- Newly graduated provider looking out to start your practice
- Including additional providers to your practice
- Getting employed with a new practice that has a different payer contract
- Would like to get credentialed with any new payer out of your list.
Outsourcing Provider Credentialing
Outsourcing Provider Credentialing is proved to be the best choice to ensure faster and cleaner processing. An established Medical Billing Company should be able to cover your Provider Credentialing needs as well as keep track of re-credentialing and ongoing credentialing maintenance activities as and when required to avoid any bleak effect on your financial system.
About e-care
E-care India is one of the pioneers in offshore Medical Billing companies that promises to avoid the revenue pitfalls due to incomplete or delayed Physician credentialing and ensures exponential revenue growth with our credentialing expertise. With 20 years of experience in the industry, e-care’s 3 delivery centers have been providing Medical Billing and Physician Credentialing services seamlessly to its clients. To know more about e-care and its services, contact us today at 813-666-0028 or log on to www.ecareindia.com