After Credentialing: What's Next?
Getting your credentialing completed is a big hurdle that deserves celebration! For many therapists, it is a barrier to entry to accepting insurance that they never cross. But what comes next? Read on to learn about the steps you should take after credentialing, including insurance billing, and what you can do to make sure that the billing process flows smoothly.
Make Sure You Have Your Contract
Part of the credentialing process is receiving a contract. This contract should be signed by both you and the insurance company. If you did not receive the final copy, you may need to request it from the insurance company or your credentialing may still be in the final stages of the process. Make sure that you have that contract before you begin any insurance billing!
When you receive your insurance contract, be sure to read through it thoroughly. The contract may have some specific billing instructions that will be helpful to know when you begin billing for insurance. It also will likely include your fee schedule, but this may be a separate document of equal importance that you can request from the insurance company as well.
Save your contract, either a physical or digital copy, in a place where you will know where you can access it. It is an important document that you may want to reference later for various reasons, such as to verify when your credentialing is up for renewal, in the event of the need for any claim appeals, or to reference if you are considering asking the insurance company for a rate increase.
Set Up Any Online Portals
Most insurance companies will provide you with instructions to set up a login to their portal where you can access information that is specific to in-network providers. Portals differ from insurance company to insurance company, but many have the same goals. They allow you to access important information and announcements from the insurance company. Often, there will be billing information stored in the portal, including claim status and in some cases Electronic Remittance Advice.
You should get this login set up as soon as you can so that you can learn more about how the portal works, and what you may need to know before you begin billing. Don’t forget to store your username and password somewhere safe so that you will always have access to this portal!
If you plan to do your billing electronically (we strongly recommend this) you should also establish any EDI and ERA connections to your EHR. EDI is what will allow you to send claims, and ERA is what will allow you to receive remittance advice. We have an entire blog post that digs deeper into EDI and ERA here.
Establish Your Client Base
Once you are credentialed with an insurance company, you can begin seeing clients and getting reimbursed according to your fee schedule! You will likely be in one of two scenarios: you are already seeing clients with this insurance on a cash payment basis and will transition to billing insurance, or you will be building your client base by advertising that you accept the specific insurance that you have completed credentialing with. As an in-network provider, it is possible that you may start receiving patient referrals directly from the insurance company through an online portal. Make sure that you can find your information in the provider section of the insurance company’s website and that all contact information is displayed, and displayed correctly.
In either case, it is important that you collect the insurance information from each of your patients and input this into your EHR system. We have a great reference list of everything that you will need from your patient to bill insurance. Having all of the necessary patient information in your EHR from the start can make a big difference in ensuring that the claim submission process is smooth, and that claims are paid quickly.
This is the easy part, the part that you’re used to, that you went to school to learn how to do. Conduct your sessions as usual, but be sure to complete your notes in a timely manner! You can’t send claims to insurance (or get paid!) without completing your notes, so be sure to set up a system that works for you to get them done.
After a session is complete and your notes are finished, it’s time to bill! You will need to fill out a CMS-1500 claim form and fill in all the necessary information. This form will then get sent to the insurance company. In most cases it will first pass through a clearinghouse before getting to the insurance company. The clearinghouse reviews all information and if there is any information that doesn’t match their system, either for the patient or for the provider, it will be rejected at which point you will need to review, correct, and resubmit the claim.
This is the stage in the process where many providers become frustrated with insurance billing. Claim submission and follow up involves a lot of attention to detail, an understanding of the insurance system, and often a great deal of time spent on the phone with the insurance company. Some providers give up on insurance entirely, but we would encourage you to consider the possibility of outsourcing your billing.
Practice Solutions has helped hundreds of providers take control of their private practice by taking over a lot of what comes after credentialing, including claim submission and follow up as well as eligibility and benefit checks, allowing providers to focus on patient care and practice management. You’ve put in the work and your credentialing is complete - if the next steps are frustrating, don’t give up! Check out our services, and use the contact form on our website to get in touch for a free consultation to see if we can help.