Managing contracts with your insurance payers is one of the most complicated things that any healthcare provider needs to do. For audiologists, hearing instrument specialists, speech-language pathologists and hearing aid dispensers, the process is different than for other specialists in the healthcare industry.
Payers make it even more difficult by operating on different schedules and using different language in their contracts. Keeping track of what you need to do—and when to do it—with each of your payers can be a maddening experience. A slight oversight could mean that you would miss out on payments for months.
One important aspect of contract management is “credentialing.” If you are well-organized and ready to supply credentials and updates when they are required by your payers, you will be sure not to miss out on revenue.
Likewise, vague language in the fine print of your contracts with payers may allow them to impose arbitrary new credentials—like having an out-of-place specialist on site—that can cost revenue in the short term and cost you clients in the long term. Ensuring that your contract terms are renegotiated to prevent these kinds of changes in credentialing is an important part of a practice management strategy that will allow your practice to grow!
What Is Credentialing?
Insurance providers cannot contract with medical professionals who are not legally qualified to practice medicine. Credentialing is the process by which an insurance provider systematically collects all the necessary documentation to confirm that a potential contractee is qualified to practice medicine. The credentials collected might include proof of training, licenses, certification and/or registration, and proof of academic training.
But some insurers may require even more. If an insurance network’s quality demands are higher than the baseline legal credentialing, you may also need to provide evidence of research publication, membership in certain professional networks, evidence that your practice is of a certain minimum size, etc. While it is often to the advantage of the insurance provider to demand as much credentialing as possible, it is to the advantage of the healthcare provider to offer less, in order to avoid arbitrary exclusion from a network based on the requirement of credentials that do not have significance to one’s practice.
Steps to Credentialing
While the credentialing process can be daunting, it is, of course, possible. The steps below are a good overview of what is necessary to effectively credential.
Make a List
It’s important to be credentialed with more than just one insurance provider. The more insurance providers you credential with, the more patients you will be “in network” with, meaning you can see more people at your practice. It’s a good idea to do some research on your specific geographic area. Make sure that you are credentialing with the networks that are most popular in your area, allowing the most people in your area to visit your practice. Once you have a comprehensive list of the insurance companies you should contract with, you can proceed to credentialing.
Complete CAQH Online
The Council for Affordable Healthcare (CAQH) is used as part of most insurance providers’ application process. However, you need to be invited by an insurance company to complete the CAQH application. A few things to know about your CAQH application:
- Invitation Only - First, you need to submit an application to an insurance company. After about two weeks, call that company to ask whether they have generated a CAQH number for you. Once you have your number, you can fill out the CAQH application which will then be sent back to the insurance company you applied with.
- Fill It Out Online - Paper submissions to CAQH are usually never processed. The application is about 50 pages long and only prints in color. Once you mail it in, a data entry person needs to input your application to a computer. By filling it out online, you can skip this step and move the process forward a lot faster.
- Perfect Resume Required! - Your resume must have no gaps in employment or education. Even one day will result in them asking for something to fill the gap, slowing down your process.
- Re-Attest Every Quarter - Four times per year, you’ll need to affirm that your CAQH profile information is correct. This only takes a few minutes to do online, but if you forget, you’ll be ineligible to accept insurance and the lapse will be part of your record with your insurance payers.
Budget 10 Hours Per Payer
With all the submissions, application retrieval, follow-up phone calls, document organization and more, expect to spend about 10 hours of labor for each company with which you are credentialing. For every mistake on an application, this time will increase.
Be sure to follow up often with the insurance companies you’re credentialing with once every two weeks. Applications have a way of getting stuck in “limbo,” and if they spend enough time inactive in the company’s workflow, they will automatically expire and require resubmission. By calling every few weeks, you’ll make sure the process is moving forward, however slowly.
Consider Getting Outside Help
Healthcare Revenue Group is one of the few medical billing services providers with specialized knowledge in the hearing care industry. As a hearing care provider that accepts as many kinds of insurance as possible, you’ll have the widest patient base possible and be able to grow your practice. The credentialing process is complicated and never-ending, but with our help it can be expertly handled and folded into a sophisticated practice management strategy that will help you develop your practice as you wish.
If you’re interested in credentialing for your hearing care practice, call us today to discuss your needs and see whether we are a good fit for you!