We have credentialed healthcare providers of more types than we can list: from chiropractors to behavioral health providers to surgeons. If you are eligible to be credentialed, we can get you credentialed!
If you are fully licensed, we should have no problem identifying plenty of insurance companies and third party payers for you to be credentialed with. In some areas, some panels can be very selective or closed. In these instances, we will talk with you about the likelihood of a successful medical credentialing process. We want you to get the most out of your medical credentialing investment, but we cannot guarantee that insurance panels will accept you.
Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with. Typically most outpatient physician providers credential with 7-8 payors, where as hospital based physicians (in-patient) usually credential with 10-15 payors (pretty much any patient with any insurance that comes to hospital). Physicians working in tristate area (border of 3 states) like in our physician owner practice credential with 25 payors.
The popularity of insurance companies varies depending on location. However, some of the most popular and largest insurance companies are Aetna, Cigna, Magellan, Tricare, United Healthcare, Humana, Value Options/Beacon Health Options, Medicare, and many others.
Together, we decide what insurance companies you want to work with based on your license type and your practice location. Then our staff will begin the process of retrieving, completing, submitting, and following up on applications on your behalf. We keep in touch with you throughout the process and contact you if we ever need any additional information.
Being credentialed with insurance panels means that you are able to see patients who have specific insurance plans and bill those insurance companies directly for the services you render. This can greatly increase the number of patients who can access your services.
EFT (Electronic funds transfer) is the preferred method of payment for many insurance companies and the required form of payment for Medicare. Medicare requires you to complete form CMS-588 when enrolling in Medicare which details how you would like to be paid.
ERA or Electronic remittance advice is a digital EOB (explanation of benefits) that shows what the insurance company paid (or didn’t pay) and all the claim details. Many billing systems can automatically post these ERAs to the patient’s account.
This occurs after a provider has been linked to a Tax ID or a contract has been signed and sent to the payer for counter signature. This process typically takes 30-45 days to complete. Once this process is completed, the payer typically issues a letter or an email with the provider’s effective date and provider ID number (if issued). This is the last step before being able to bill.
A panel is usually the equivalent of an insurance company. The term is commonly used to refer to a panel of plans. This is demonstrative of the fact that when a provider is on a panel he or she can bill for all of the plans under that panel.
