Everything You Need to Know About Insurance Credentialing

Everything You Need to Know About Insurance Credentialing

Posted on August 5, 2021

Insurance credentialing is the process with which certain insurance companies tend to verify the training and education along with the professional experience of the medical professionals to ensure that they can meet the requirements for serving as the in-network provider for any particular panel. Most healthcare professionals these days tend to opt for insurance credentialing to prevent the patients from getting claims that reach outside their network deductible.

What Are The Importance Phases of Insurance Credentialing?

There are 2 important phases to the entire process of credentialing with any particular insurance network. These phases are known as credentialing and contracting. In the contracting phase, the company will issue a participating provider agreement to the profession with certain defined participation terms provided to receive the in-network charges for several claims. Without having the agreement of the participating provider, there is no chance of receiving the in-network reimbursement from the insurance network. Until both the phases are complete, the professionals can bill the network using their out-of-network technique. However, there is no guarantee for the processing of the claims in the first place without the completion of contracting and credentialing.

How To Prepare For Contracting And Credentialing Process?

Mentioned below are some of the important steps that one needs to keep in mind to prepare in the best way for the contracting as well as the credentialing process.

  • Establishing a particular business entity that can be used for practice such as (S-Corp, LLC, PC, etc.). It is also important to obtain the tax ID for that particular business entity.
  • In case the professional is a sole proprietor, they need to consider having a particular federal tax ID to make the operating process a bit smoother.
  • Obtaining the insurance policy of professional liability.
  • Obtaining the NPI number that is provided to the individual along with the NPI number of the business entity as well.
  • Professionals also need to have their full license in the certain state that they will be providing all their services. That also includes the prescriptive authority.
  • Creating the profile with the help of CAQH and keeping it current and working.
  • Having the practice location completely ready.
  • Making a list of all the potential insurance networks that they want to go ahead and participate with.
  • Create a profile with CAQH and keep it current.
  • Have your practice location ready.
  • Know which insurance networks you want to participate with.

Conclusion

After preparing for the contracting and credentialing phases, the professionals can go ahead and contact their provider for the insurance network and then make inquiries about the process to get it started. Right after the completion of the 2 phases, the professionals will be able to become a part of the insurance network label without any trouble.

Choose Flatworld Solutions for Superior Quality Insurance Credentialing Services

Flatworld Solutions has been a pioneer in providing the best quality insurance credentialing services and a series of other insurance BPO services to clients around the globe. We have some of the most experienced and skilled insurance credentialing experts in our team who can take care of all your needs. We make use of the latest tools and technologies while delivering top-notch services.

If you are looking for a reliable and cost-effective insurance credentialing service provider, then you have come to the right place. Get in touch with us today!

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