There’s a lot of information to know about credentialing, and sometimes it can be confusing. You can always expect changes in the process or variations among payers or insurance companies. These changes would many times cause interruptions in a practice’s reimbursements and the whole revenue cycle. And because of that, it is quite important to be familiar with the changes that are happening around your profession.
- Required documents. Knowing what documents are needed in your submission is among the very first things that you should know as a provider. Submitting incomplete or wrong documents can cause problems that will eventually lead to loss of income for the provider and the practice.
- Banking information. The provider must have a bank account opened in the practice’s name. Enrollment can not be processed without a voided check or bank letter signed by an authorized bank official.
- Malpractice insurance. It is impossible to have an active practice without it. Copy is required by many insurance companies and it is a must for CAQH.
- Form of submission. In recent times, insurances companies opted for digital submission of claims to adapt to current times, situations and to ensure security and efficiency of claims processing.
- CAQH. Many insurance companies are now turning to CAQH for credential verification. One of the largest carriers is Blue Cross Blue Shield of Michigan. Blue Cross previously requested verification through PrimeHUB; an authorized individual would attest to the information on file for a given provider, or any number of providers. Now, Blue Cross sends requests for a provider’s CAQH profile to be updated and attested for. The attestation is crucial to provider enrollment – CAQH profiles must be attested for no earlier than 14 days before submitting enrollment applications. Blue Cross has advised us that they pull information from CAQH profiles every Monday.
- PHOs or Provider Health Organizations. Providers can join one of the many organizations that can help with credentialing. PHOs have a list of health insurance carriers that will be helpful to any provider by way of enrollment & credentialing or simply availing of information. Joining a PHO will give one an advantage over providers who are not members of a specific PHO. When a provider chooses not to join a PHO, they risk being unable to get in a network with an insurance carrier who has contracts with PHOs.
