Credentialing is an important process for any healthcare provider, straddling the interface between professionalism and regulatory compliance. Understanding it can greatly improve a doctor’s efficiency when dealing with various parties involved in patient care including insurance companies. In this comprehensive overview, we will delve into Step 4 of the process: Discovery and Research.
1. **Understanding Payer Requirements**
In essence, Step 4 revolves around understanding what specific payers require for you to be credentialed with them. You start off by visiting their websites and going over their laid-out requirements; however, if these are not available or are too complex to understand based on website information alone, customer service should be your next line of approach.
2. **Why Call Customer Service?**
Calling customer service provides more than just clarity – it also gives you the opportunity to ask questions and confirm that you have understood all requirements correctly before proceeding further.
This helps prevent errors during application that may cause a delay in processing time costing both money and convenience.
3. **Initial Forms And Creating Your Profile**
Payer websites usually provide an initial form or mechanism aimed at getting your profile started towards credentialing with their platform.
You fill out this form as accurately as possible then wait seven to ten business days for them to contact you outlining next steps required in establishing your professional identity on their network platform.
4. **Professional Groups & Credentialing At Scale**
One key point that providers often overlook when seeking credentialing is grouping contracts together rather than treating each individually – specifically when there might be growth within the practice down the road,
thus creating group National Provider Identifiers (NPIs) would help save time red-tape wise as additional practitioners join over time.
Being specific about wanting group terms mapped onto all individual applications made under this package helps avoid confusion regarding individual versus group contracts later on.
5 . **Strategizing For Future Growth**
Planning for the future when starting your credentialing process can save many headaches later on. You might be a sole provider right now, but if there’s any chance of expanding or bringing in more providers down the line, do your groundwork now. Confirm with each payer about how to handle additions or changes to your practice.
Conclusion
In conclusion, Step 4 of the credentialing process is all about efficient research and making smart decisions for immediate needs as well as preparing for possible future expansion. Consistently updating knowledge and being able to ask the right questions will assist in ensuring a smooth credentialing journey.
Remember, contracting and credentialing within medical practice is akin to playing chess; it’s not just knowing how each piece moves but also predicting where they should be two-turns ahead.
Next time you are waiting on hold with customer service remember this: Why don’t doctors play hide and seek? Because good luck hiding when your pager keeps going off!