Frustration, time consuming, and “limbo,” are words often associated with the credentialing process. Unfortunately, credentialing has little structure and standardization which makes the application process difficult in this high-tech era we live in. There are a lot of manual steps along the way which in turn mount stress, create errors, and cause substantial delays.
Thankfully, Inlera has found five ways to better the process and leverage technology to make credentialing happen both faster and cleaner. Keep in mind: properly keeping up with the credentialing process will allow your practice to grow by becoming an in-network provider with insurance companies.
Organization
Obtaining and maintaining the documents and records needed for the credentialing process is imperative. Before the process begins, every document needed should be gathered, as some forms cannot be saved once you start them.
Thankfully, many insurance companies utilize CAQH Pro View, which is one centralized resource for insurance companies to tap into. Most major insurance carriers use CAQH as a part of the application process. When using CAQH, every document must be approved and uploaded in one step (i.e.: an updated CV, references, past work history, etc.).
Be Thorough
A popular phrase that goes hand in hand with the credentialing process is “garbage in, garbage out.” If a mistake is made along the way, the application process will be delayed or completely rejected. This can sometimes be weeks or months later, resulting in having to start the process from the beginning.
You should utilize your peers to help double check your application before submitting it. When every detail matters, it’s essential to ensure there are no mistakes. For example, one wrong digit in an applicant's banking information will result in no payments months down the road.
Be Persistent
When the application process is completed, the work does not stop. It just turns into a waiting game. Some insurances take up to 60 days just to pull credentialing information to proceed to the next step.
Many credentialing follow-ups from insurance companies occur through snail mail or email, so they are easy to miss or be misplaced. Continuous follow-up from your team can help an applicant jump the list and avoid unforeseen delays.
Communicate
The longer it takes the applicant to communicate, the longer the process can be delayed. If an application has been misplaced or reviewed improperly, knowing right away will ensure the application doesn’t get stuck in credentialing limbo.
At the same time, if an application sits too long with the insurance company, there’s a risk it will expire or be automatically rejected. Constant communication and follow-up with the insurance company you’re trying to get credentialed with can ensure this does not happen.
Document
There are a couple types of documentation necessary when you are going through the credentialing process. If you are not taking the proper steps in documenting, there are many consequences you could face, including treating patients without being credentialed.
Be responsive to any notifications received during the process to avoid delays in your application. You should document all communication you have with the insurance company; for example, writing down reference numbers and names of representatives you speak with. You should also document any dates given to you by the insurance company. For instance, writing down when follow-up calls are made and when an insurance company issues an effective date.
How Inlera Alleviates the Stress
While the credentialing process can be both overwhelming and time consuming for many providers, Inlera is here to help. A practice that runs smoothly relies heavily on proper credentialing and documentation.
Through constant communication, follow-up, and overall commitment when it comes to the credentialing process, Inlera makes it easy for providers to get credentialed with numerous insurance companies.
We’re here to take the credentialing process off of your already full plate.
Jasmine Vializ is the President and CEO of Inlera, a billing and practice management company designed to increase the quality of healthcare by helping doctors to prioritize their patients while boosting their bottom line.
