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Medical Credentialing
Medical credentialing is the
process of applying to participate (become par, join the panel,
become in network) with an insurance carrier. If the
insurance company is accepting new providers in your specialty and
your location, an application is completed by the provider and submitted
to the insurance company. If accepted into the network, the provider
will then be granted specific privileges with that insurance carrier.
Much information is requested as to schooling, licensing,
experience, liability insurance coverage, languages spoken, etc on the
application. These applications can be lengthy and vary
greatly.
The major advantage of going through the
process of credentialing and participating with the insurance
company is that patients are more likely to
use the services of a participating provider. When you
participate you agree to accept a set rate of payment for your
services and payment goes directly to the provider. In order to treat a Medicare patient, you must enroll with Medicare even
though you may choose to be non-participating. Here is more
information on Medicare credentialing.
Some
companies have their own applications, but what is becoming very popular
with the insurance carriers is the universal CAQH credentialing process. Many companies
now require that you are registered with CAQH where the insurance
carrier can then examine your credentials online to determine if they will accept the provider to participate or to renew their
contract.
The CAQH application eliminates the need to complete an
application for each individual insurance company. The application
can be completed either online or on paper. The purpose of the
universal application is to eliminate the need for individual
credentialing applications for each insurance company.
When
a provider notifies an insurance company that he or she would like to
apply to become participating, the insurance company can go to the CAQH
application and find all the information they need without the provider
completing yet another application.
You may still be required to
fill out some paperwork for the individual insurance carriers, but it will
be minimal. CAQH is the way of the future so it's a good
idea to go ahead and complete the lengthy application for your
credentialing.
Return to home from Medical Credentialing
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