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  • Practice Solutions

3 Credentialing Protips



Main Points


  • Collect all the information that you will need to walk through the process


  • Submit the application ASAP


  • Follow-up regularly


Applying to insurance panels can be a long process. We are talking about 90 to 120 days before you can start taking patients with a particular insurance plan. That means that you will need extra money to help get through that waiting period.


But it also means that you will have to walk through the process as best you can while you wait. There are very clear and evident actions that you can take while applying to be an in-network provider. While there is a lot of waiting, here are some things that you can do to help your insurance applications process smoothly and as quickly as possible.


The first pro tip that we can offer if you are going to apply to the insurance panels on your own is to collect all the information that you will need to walk through the process. Well, what is that information?


Here are some of the bits of information that you will need if you are going to apply to an insurance panel:


  • CAQH Account

  • NPI Type 1

  • NPI Type 2

  • Tax ID or SSN

  • An office location

  • A mailing address if applicable

  • PECOS account (if you are applying to Medicare)

  • License number

  • Any applicable certifications

  • Populations that you serve

  • And lots of time

You will want to make sure you have all of these parts in a singular location, like a spreadsheet so that you don't have to continually look and search for them through the process.


Once you have all this information in an organized system, you have all that you need to start the process of applying to an insurance panel. You will now need to decide which insurances you are going to take in private practice.


Here are some questions to ask yourself as you start to decide what insurance you are going to take:


  • What insurances do other practices take in my area?

  • Is there a population that I would like to work with?

  • What some of the rates that I can expect from the insurance companies?

  • What is the experience of working with each insurance company?

  • Is there a large company that offers a certain insurance plan that I should consider taking?

  • What do most people have for insurance in my area?

The answers to those questions can help guide you through what insurance companies you want to work with.

At this point, you have all the information that you will need to apply to the insurance panels, but now what? Now you need to submit the application ASAP. The reason why you need to submit the application to the insurance ASAP is because of the length of time that it can take to process an insurance application.


This is one of the hardest parts of the process!


Basically, what you will need to do is find the insurance company's application to become a provider for your specialty.


Once you find the application online or are sent an application, you will need to fill it out. This will take an inordinate amount of detail!! You will need to pay attention to each and every section on the application. Any misstep on this part of the process could mean a further delay of getting on the insurance panel or a complete rejection from the insurance panel.


One tip that helps with this part of the process, if you are doing this yourself, is to have someone review the application before you send it. Pick a person to review your application that you know is a stickler for detail and will not be afraid to point out any errors on the application.


Once you are sure that the application is correct, then you can submit the application according to the instructions on the application.


This is particularly relevant!!!


If you don't fill out and submit the application exactly how the insurance companies want the applications to be submitted, then you will run into further delays.


The last step in the process is the most boring. Follow-up regularly. This part of the process can be boring because you will get a lot of canned answers and dead-ends.


But don't lose heart! By following up with the insurance companies on a regular basis you ensure that they are chronically thinking and looking at your information. The old adage still holds value, "The squeaky wheel gets the grease".


I would go back to the spreadsheet that you have that contains all of your practice information and I would start to document your follow-up activities. Document each follow up with the following columns:


  • What number did I call?

  • Who did I speak with?

  • What did they say about the status of my application?

  • When did they say it was going to be completed?

  • What is the call reference number?

  • When am I going to follow up again?


By keeping those records you are ensuring that your application is going to continue to move in the right direction. With these tips, you will be able to manage the credentialing process from start to finish with as little bumps as possible.


If you have any questions don't hesitate to reach out to us and we would be happy to answer any questions that you have!