Do you find yourself constantly jumping through hoops when it comes to credentialing?
Insurance companies have many hurdles in place to delay payment and oftentimes, credentialing providers can be one of the most exhausting - especially when you don’t want to focus on paperwork but instead on patient care and the customer service experience within your practice!
Here are some common hoops we see in credentialing and ways they can be combated:
Insurance panels closed:
It can take up to six months to hear back from an insurance panel once you have submitted an application! And after all that waiting, the insurance companies can come back saying that they are not open to taking new providers. This is incredibly frustrating but the best thing you can do in this time is be persistent. Continue to apply every 3-6 months. Follow-up with statistics and outcome measures as to why your practice should be selected to enter into the plan.
Extended wait times for processing especially due to COVID-19:
While waiting is the name of the game when it comes to credentialing, since COVID-19, we have seen even longer processing times due to the transition to remote workplace and the payors focus on putting in place waivers for Covid-19 emergency. We recommend continuing to submit credentialing in a timely manner but anticipate prolonged approvals times and plan for co-signs in the interim. Again - this is where persistence is key! Continue to follow-up regularly with the payors to ensure your applications are processing.
Lack of communication with your billing team causing denials:
Your billing and credentialing departments should have a solid process in place for communicating credentialing status’ and how that directly affects the submission of claims. It’s essential that your credentialing department shares all crucial information, including: pending, approved, and terminated credentialing status’; claims that need to be held and when those claims are okay to be submitted; and contract intricacies to ensure that the EMR and claims reflect the contract details. If not, you will see denials that are often not appealable.
We know that credentialing and re-credentialing and the hoops they have can cause you and your practice headaches and cause delays for cash flow. If you are interested in having LRS handle your credentialing, contact us to learn more!