Why we want to manage the Credentialing and Contract process for your practice:
Credentialing is the most important step when starting your new practice or hiring a new practitioner within your valued practice. Failing to manage the credentialing and contracting process could likely cause a loss in revenue. The Credentialing process is a very complicated process. While important for the success of a clinical practice, “getting credentialed” on insurance panels is often an unwelcome distraction from providing quality care to patients. Enrollment applications can be 30+ pages long, and to ensure smooth processing there’s a lot of necessary, time consuming, follow-up. This is where we will step in and take the lead for you. We will become your Credentialing Management team and we will do all of the work for you! No stress for you and no worries along the way.
Facts:
• When starting a new practice and when your provider tax-id changes, most of the time new
contracts will need to be acquired.
• When you move to a different state, new providers will need to be credentialed and new contracts will need to be obtained.
• When adding new providers and practitioners to your practice, most insurance companies will require group contracts. Each new provider will be required to be credentialed or have a singular contract that will pay to the individual practice taxid.
• If your practice decides to accept new insurance payers in the future, this will also require
establishing contracts with the insurance companies.
What is a CAQH?
The CAQH is an important aspect of all medical credentialing and should be completely set up in order to even begin the credentialing process. In order to get a CAQH ID so that one can complete a profile, one must contact an insurance company for that number. We recommend doing this with Humana or Aetna. Once you have received your ID, you will go to www.caqh.org and complete your profile. This profile is essentially your application for a lot of insurance companies. You will want to make sure that all of the information within the profile is accurate. When you go to apply to the many different insurance companies, there will be a place on you initial request to join the company that you will put your CAQH number. We will assist you in creating your online profile and obtain your CAQH ID. We will manage and maintain your online profile with CAQH so that insurance networks that participate will always have access to your credentialing information, without you having to lift a finger.