Keeping Your Credentialing Up to Date


Credentialing with an insurance company involves a lot of time; time figuring out how to begin, time spent completing paperwork, and time waiting for your application to process. That time is an investment in your practice, and the last thing you want is for that time to be wasted by missing the deadline to renew your credentialing.


After you’ve completed the insurance credentialing process for your Private Practice, there are certain responsibilities to upkeep that status with the insurance company. One part of these responsibilities is re-credentialing after a certain period of time since you first contracted. Different insurance companies have different expectations of when your credentialing needs to be renewed, so be sure to read all communications from the insurance company thoroughly! Missing the renewal with an insurance company could mean that you end up starting the credentialing process from scratch, which is much more time consuming than the renewal. You can save yourself the headache with the following tips.


Regular Upkeep

Whenever any of your information changes such as address, NPI number, tax ID, or contact information such as a phone number or email address, you will need to update the insurance company. A good rule of thumb is that if any of the information included on the credentialing application changes, you should be updating your information with the provider services department of the insurance company. Making sure that the insurance company has accurate information on file for you and your practice can make the renewal process that much easier.


Renewing Credentialing

Review Your Contract and Communications from the Insurance Company

The best way to know when you need to re-credential is by reviewing any communications that you have from the insurance company. When you first get credentialed you should receive a contract outlining the terms of your relationship with the insurance company. They may state for you the time period that you will need to re-credential. You may also receive a notice from the insurance company leading up to the re-credentialing period detailing everything that needs to be completed.


Any communication from the insurance company should also give you detailed information on how to go about completing the renewal process, however if you find yourself needing assistance you can reach out to a provider representative at the insurance company or get in touch with their provider services area. Since each insurance company does things a bit differently, the best source of information is within the insurance company.


We recommend keeping a record of the process with any notes that you may find useful when it comes time to renew again. At the time of renewal, you can also confirm when you might expect to need to renew your credentialing again and create a reminder in your calendar so that you don’t miss the next renewal period.


Why Do I Need to Renew My Credentialing?


The purpose of re-credentialing is so that the insurance company can verify that they have all of the most relevant and accurate information for your practice, and so that they know you are still accepting and seeing patients with that insurance. It also allows you the opportunity to evaluate whether or not the relationship with the insurance company is proving to be valuable to you. We are proponents of the idea that “Less is More” when it comes to the number of insurances that you accept. If the time to re-credential comes and you no longer feel that the relationship with the insurance company is valuable, it is a great opportunity to let the contract expire and open up a spot on that panel for another provider.


If you are still finding the relationship valuable, renewing your credentialing is typically easier and less time consuming to complete than the original credentialing process. The renewal process is another way for insurance companies to protect against fraudulent claim submissions, and is one of the reasons that the process was implemented. As long as you keep up with notices and instructions from the insurance company regarding renewing your credentialing, you should be good to continue to submit In-Network claims and receive payment.


Missing Renewal Deadlines

So what happens if you miss the email reminders and don’t renew your credentialing in time? Unfortunately, this can mean that you lose in-network status with the insurance company. At the time of your contract expiry, you will no longer be able to submit claims and receive the in-network payment rates. If you discover that you’ve missed your renewal and you want to continue your relationship with that insurance company, you will most likely need to start the credentialing process from scratch and this can take up to several months for the application to process. This can mean headaches for you, for your patients, and for your biller as well!


The best way to avoid this scenario is to make sure that you have a good understanding of your insurance contract, you are set up to receive emails and communications from the insurance company to your current email or physical address, and you thoroughly read these communications.


If you are having a hard time understanding expectations from the insurance company, or with claim denials due to credentialing or renewal errors, Practice Solutions is here to help. Our billers are experienced with all of the major insurance companies, and by signing up for our billing services we can help you to identify any issues and point you in the right direction to resolve these issues while relieving you of the burden of insurance billing. If you are interested in finding out more about our services, reach us at info@practicesol.com or by calling 734-437-9432.


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