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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.
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.
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Credentialing
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