Getting on insurance panels is an essential step for any practice, but not an easy one. There are very specific steps necessary to get there. It starts with putting together the credentials information and documentation.
Necessary Documentation
Some of the information the practice will need to provide to get on panels includes:
- Licensure details
- NPI numbers for all practitioners
- Resume for all practitioners
- Proof of malpractice insurance
- Proof of liability insurance if the practice owns the property
- Proof of liability insurance if the practice rents office space
- Taxonomy code for Medicare/Medicaid
- Credentialling paperwork
The next step is to complete the Council for Affordable Quality Healthcare (CAQH) application.
CAQH
CAQH is a non-profit alliance that helps to streamline healthcare administration using the latest technology. The CAQH ProView is a credentialing database many insurance companies use when considering practitioners.
Completing the CAQH registration and application process can be time-consuming, so plan accordingly. There is an online application process that makes things more accessible at the alliances’ enrollment hub.
Before starting the insurance provider application process, ensure the CAQH profile is accurate. Double-check key details such as practice address. Also, verify that all the required documentation is there. Return quarterly to update the profile information to keep it accurate. The insurance company application process can take months.
Contact Insurance Providers
The application process will vary from company to company. Contact them once all the credentialing is in order. That information is often available on the company’s website. They will probably provide access to an application to download, as well.
Set aside plenty of time to complete each application. Read through the application once before beginning to ensure you follow all the steps to apply. Sign and date the application and include copies of necessary documents. Retain a copy of the completed application for the practice records.
Be ready to respond to any request they may have for additional information or documentation. Then, follow up with them to ensure they received them.
After Applying
Continue to follow up with the insurance company regularly until they finish the process. Once approved, they will provide an effective date and a participating provider agreement. Record that date plus the provider ID for all the practice practitioners.
After the paperwork is complete, confirm the directory entry to make sure it is accurate. Also, write down the re-credentialing date, so you can have the paperwork ready to avoid an interruption in the contract.
File Multiple Applications
Contact each insurance company that looks promising. It may be necessary to fill out many applications. Not all networks accept new providers. Some may only look to add them in critical regions. If they are not taking applications, make a note to check back once or twice a year.
Practitioners who work with insurance companies while with other practices will need to reapply. This is because the contract does not carry over from practice to practice.
