6 Best Practices for Insurance Credentialing

Every provider who receives reimbursement from an insurance company has to be credentialed in order to be accepted into that payer’s network. The process of credentialing can be time-consuming and complex, but there are some best practices that can make this task run more smoothly.

Why is insurance credentialing important?

The obvious importance of insurance credentialing comes from its vital role in receiving reimbursement from third-party insurance payers. However, the role insurance credentialing plays in the healthcare industry doesn’t end there.

Insurance credentialing serves as an important safety check that requires clinicians to prove they have the appropriate training, education, and licenses to provide patient care. Going through this important safety check also improves trust. When a provider is credentialed, patients can be confident that they are receiving appropriate care from someone who received the proper training. Without this trust, patients can doubt diagnoses, neglect treatment plans, and see negative outcomes.

Credentialing carries some protection from lawsuits. In the event of a malpractice claim, being able to prove that a provider was properly credentialed can help to shield your organization from some liability. This can also help to avoid fines related to legal issues.

Finally, credentialing helps to boost provider reputations. Patients today are researching their providers and looking for the very best they can find. Knowing that a provider has successfully completed all the necessary steps to be credentialed can shed a positive light on that provider and make a patient more likely to choose them for care.

6 Best Practices for Insurance Credentialing

While insurance credentialing is a complex and time-consuming process, there are certain best practices that can help to make the process run smoother than it would have otherwise.

1. Research the difference insurance companies and their specific credentialing processes. Every company has a slightly different credentialing process, so before getting started it’s a good idea to thoroughly research each company, note their processes, and determine which ones you want to be credentialed with so that you’re prepared.
2. Be ready to commit time to the process. Credentialing is not a process that can be completed in a matter of days. Go into the process expecting it to take weeks, if not months, so that you can allow the appropriate amount of time and have proper expectations. Then, if the process moves more quickly than expected, it’ll be a pleasant surprise.
3. Request to participate. There is a step that allows you to have access to a health plan while your application is being processed, and it’s called a Participation Request. This allows you to join the insurance company’s network through a link on their website, at which point they will call up your application, verify it through a number of databases, and then submit it to the credentialing committee to approve.
4. Always follow up. Remember, you are not the only one going through this process and things sometimes go awry. Without following up on your application, it could get lost. Following up roughly every two weeks is a good idea to keep the ball rolling.
5. Keep copies of everything. Make sure you keep copies of every form, contract, and enrollment letter you receive from insurance companies. Again, you’re not the only one going through this process and things can get lost so you’ll want to have accurate records.
6. Consider outsourcing the process. Credentialing is a complex process that takes a lot of time. It might be a good idea to hire a credentialing service to take over the process for you, as they have a wealth of experience to help things run smoothly.

For those undertaking the task of insurance credentialing for the first time it can be quite intimidating, but with the right amount of attention and planning it’s far from an impossible task.

By utilizing the best practices we’ve listed above, even a credentialing newcomer can experience streamlined success.