Credentialing With Insurance Companies: 5 Mistakes to Avoid
Before working for any practice, healthcare providers must get verified by insurance companies in order to receive reimbursements. This process, known as medical insurance credentialing, is vital for streamlining the healthcare revenue cycle and improving the patient’s overall experience with a facility.
Credentialing with insurance companies is necessary for administrative billing, but it can be time-consuming and cause more stress than necessary if not done properly. In this article, we’ll provide an overview about what insurance credentialing is and outline five mistakes to avoid during the process.
What Is Medical Insurance Credentialing?
Medical insurance credentialing is a process in which healthcare providers are screened and verified by insurance companies to get reimbursed for their services. When a provider is credentialed by a particular insurance company, they’re classified as an “in-network” provider for patients covered by that insurer. This enables the provider to bill the insurance company directly and receive reimbursements for the care they deliver.
How Long Does It Take to Get Credentialed With Insurance Companies?
Providers must go through the credentialing process for every insurance company that they want to establish a contract with. The length of time that it takes to get credentialed depends on several different factors, such as the type of insurer, a provider’s background, and state regulations. But, on average, it takes about 60 to 90 days to become verified by a commercial payer and 40 to 60 days to be verified by Medicare and Medicaid.
Why Is Insurance Credentialing Important?
Every practice that wants to be reimbursed by insurance companies must go through the credentialing process. Credentialing with a diverse range of payers can help you grow your patient base, since you’re able to accept a variety of insurance plans. For patients, this also helps improve affordability and accessibility to the services that they need.
How to Get Credentialed With Insurance Companies
You may also be wondering how to get credentialed with insurance companies. Mental health professionals, doctors, nurse practitioners, and all other types of medical providers typically follow a similar process. However, each state has its own requirements, so it’s important to check with your licensing board to confirm whether or not you need to get credentialed. Beyond this, credentialing with insurance companies generally involves five key steps, outlined in the table below.
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| 1. Apply for/update your NPI | Your national provider identifier (NPI) is a unique 10-digit number you’ll use to identify yourself during the process. |
| 2. Research insurers | Research which commercial insurers are commonly used in your area and federal/state-based programs like Medicare and Medicaid. You can also submit pre-applications to insurers to check if you meet all of their basic qualifications. |
| 3. Gather information | After submitting pre-applications, you’ll need to gather all your information such as your background, licensure, malpractice insurance, and tax ID. Refer to an insurance credentialing checklist for a full list of necessary documents. |
| 4. Complete the application | After gathering your documents, it’s time to complete the full application provided by an insurer. Many insurers use the Council for Affordable Quality Healthcare (CAQH) database. |
| 5. Finalize a contract | Once your application is approved, you’ll need to finalize a contract with the insurer that specifies which of your services are in-network, any benefit-filing responsibilities, and how much you’ll be reimbursed for each service. |
5 Mistakes to Avoid When Credentialing With Insurance Companies
Now that you have a better understanding of what medical insurance credentialing entails, you may be wondering how to make this process as seamless as possible. Here are five common mistakes that providers make and tips to help you avoid them.
1. Not Researching the Requirements of Each Insurer
Conducting thorough research is crucial for understanding how to get credentialed with insurance companies. Physical therapy professionals, physicians, and other types of medical providers may follow a similar process, but they all have different types of information to gather. Not taking time to understand the unique requirements of each insurer can cause delays in the credentialing process and even lead to mismatched expectations in reimbursement rates.
Tip: Some insurance companies in your area may not be open to accepting more providers if the market is already saturated with your services. Make sure to double check availability with an insurance representative prior to starting an application.
2. Delaying Communication or Missing Deadlines
Every insurance company sets strict (and often tight) deadlines for when information must be submitted. Missing these deadlines or taking too long to respond to direct inquiries can lead to delays or denials.
Tip: Deadlines can creep up quickly, especially for more detailed applications. Set up automated reminders that notify you about upcoming application and renewal deadlines. This will help you plan ahead and get all of your documents together ahead of time.
3. Providing Inaccurate Information
Getting credentialed with insurance companies can be a tedious and lengthy process, so it’s common to make typos when inputting information. However, significant errors can drag out the process, so it’s important to meticulously check your information prior to submitting your application.
Tip: Opt to go digital if an insurance company gives you the option of submitting your application online or by mail. Credentialing with insurance companies online can help prevent errors since application systems will automatically detect missing fields or mismatched characters.
4. Maintaining Insufficient Records
In order to maintain a contract with insurance companies, providers typically need to go through a regular renewal process (every one to three years). If you’re not properly storing all of your records, you may be left scrambling when it’s time to renew your insurance credentials.
Tip: It’s important to have electronic back-ups of your most important documents in case information gets wiped or lost. You should also keep additional paper copies on hand in case you need to manually scan and upload them again.
5. Forgetting to Update Information
If any of your personal or professional information (such as your address or practice location) changes between renewal periods, notify the insurers you’re working with in a timely manner. Failing to do so can lead to delays or issues when it’s time to complete a renewal, or if an insurance company reaches out to clarify your information.
Tip: Create automated reminders to renew your professional licenses and certificates. This ensures that all of your credentials are up to date when it’s time to send updated information to insurance companies.
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