For many licensed medical professionals, medical credentialing is known as
1) “the process of becoming contracted with insurance companies”, or
2) “the process of getting on insurance panels”, or
3) “what you need to do to be able to accept insurance.”
How do I Become Paneled with Insurance Companies?
The idea behind medical credentialing is simple. You (the medical provider) choose which insurance companies, EAPs, or the government programs (Medicare, Medicaid) you want to work with. You apply to be a “networked provider.” You get approved and begin seeing patients.
Ok, Medical Credentialing isn’t quite as easy or simple as it sounds (and as we all wish it were). The process gets a bit more complicated when you take a closer look.
To help you get started with credentialing, here’s a basic step-by-step guide.
Medical Credentialing Steps:
1) Decide what insurance companies you want to be a provider for.
If you’re not sure what insurance companies you want to work with, start with the major ones: Blue Cross / Blue Shield, Aetna, Cigna, United Healthcare, Tri Care, Medicare, Kaiser Permanente (if you’re on the west coast), and Magellan. A good way to identify what plans are popular is to ask some friends and colleagues what insurance they have personally. Alternatively, you could call a medical practice in your area and just ask them what insurance companies they serve—they’ll probably tell you.
2) Contact insurance companies to request a provider application.
This can be harder than it sounds. Expect to spend about 30 minutes on hold, only to then be told to call another number, or get someone’s voicemail, or (about 20 percent of the time) find that no one is available and there’s no option to leave a message (meaning you will need to call back again). Tips: 10 am is a good time to call, as is early afternoon (around 2pm). Some insurance companies are open until 5pm Pacific Time. There are also email addresses that you can write to—sometimes you’ll receive a response, and sometimes you won’t.
3) Complete and submit the provider application.
Once you receive the application, complete it fully, make a copy—and then send it back.
4) Complete CAQH
CAQH is a secondary application process, and is an adventure on it’s own. It’s step number 4 because you need to get a CAQH provider number from one of the insurance companies you submitted an application to before you can go online to complete the CAQH provider application (which is a whole lot like the first application you already completed, just longer). For more information on CAQH, we’ve given it it’s own article on one of our sister sights. See: Get on Insurance Panels: Tips for Completing CAQH.
Congratulations, you’re halfway finished with being credentialed on your first insurance panel. Stay tuned, because in our next article we will be talking about the final 4 credentialing steps.
5) Check in on Your Application
6) Follow up on any Problems
7) Check in on your Application, Again
8) Wait for your Acceptance Letter!