• Practice Solutions

Credentialing Series Part 3 of 4: Group Credentialing!


Main Points

  • It is not always easier to add providers to a group

  • Limited-license providers are tricky and depend on states rights

  • Benefits for raise increases as a group vs. individual

Perhaps you are growing a group practice or are just starting out and want to grow your practice into a group practice. This post is for you. This post will serve as a primer to those of you who are interested in group credentialing and paneling.

The first thing to understand about group credentialing is that filing an application for a group practice happens when you fill out the application. So, if you think you will want to grow into a group, you will want to make sure your application indicates that you are credentialing as a group as well as an individual within that group.

Pro-tip: Some companies won't allow you to have a group contract until you have a minimum number of providers, so be sure you know the regulations in your state for those insurance companies.

So, let's say that you have your group contract and you are looking to add providers to that contract. Is it easy to add providers to the already existing contract?

The answer is: it depends! Some insurance companies make the process pretty straight forward. You fill out a provider add form and then they add the provider to your group and send you confirmation. Some insurance companies require a new application and the standard processing time is 60 - 120 days.

Here are some suggestions for making that change:

  • Make sure that changing or adding the provider to the group contract doesn't impact any existing contracts or organizations that the provider may continue to work for

  • Be prepared with all of the materials from the first blog post in this series. That list will make the process much easier

  • Make sure you know and understand each insurance company's policy around adding providers to your group

Let's say that you are a successful practice owner and you are looking to hire the exact right therapist for your practice. You happen to stumble upon the right therapist for your practice, but they are a limited-license provider. Are you allowed to add them to the group contract?

The answer here is that it depends on state law and the already existing contract that you have. If this is something that is important to you or that will be important to you, make sure that you sign an insurance contract that addresses this particular issue.

Pro-Tip: Utilize the small business association in your state to connect with professionals that have dealt with this issue. They have valuable resources and can help with this process from a state law perspective without the cost of an expensive lawyer.

You can always lean on the ACA, NASW, or APA for more information or resources as well!

Finally, let's assume you have grown a stellar practice with a variety of patients and therapists that meet a wide range of needs in your community. You have run this practice for years and you have not seen an increase in your insurance rates. This would be an appropriate time to explore requesting a rate increase.

You can go about doing this by contacting your insurance company's provider service department and asking what the process is. Usually, it involves sending in a W9 or some other identifying document with a letter requesting a pay increase.

Here are some tips to help navigate requesting a pay increase:

  • Include the zip codes that you serve

  • Include your certifications or specializations

  • Be vague when comparing rates from other insurance companies

  • Talk about the various populations that you serve

  • Talk about the specialties that you have in your practice

  • Talk about your practice diversity and long standing work that you have done in your community

  • If you can quantify recidivism rate decreases or any other value based outcome, then you will want to mention those numbers

  • Discuss your plans for the future of your practice and how you are planning on serving those patients better in the future

Having a group contract will really set the stage for your rate increase requests in the future.

Stay tuned for our last blog in the series: Closed Panel and Denial Management

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