What Insurance Companies Are Best to Get Credentialed With?

Some of the most crucial things that a healthcare provider has to do before attending to the patients includes getting credentialed by insurance companies. Selecting appropriate insurance panels will define your practice growth, access to patients and revenue. However, there are too many insurance companies in the market; so the question arises: what do you do to select the best of them to get credentialed in? This will assist in being able to make a choice.

Why Payer Selection Matters

Insurance companies do not provide all the benefits to the providers alike. Others pay back more. Others grant access to bigger networks of patients to providers. And there are some more convenient and quick to have credentials. Choosing the correct ones at the beginning of the process can be time and stress-saving, as well as offering an easier way to begin serving patients and receive payment later. This is the reason why both new and experienced providers want to know what are the best insurance companies to get credentialed with.

Criteria to Evaluate Insurance Companies

There are some important things that providers need to consider when selecting the payers to credential. To begin with, it is important to look at the patient volume. We at Credex healthcare knows, Medicare and Blue Cross Blue Shield (BCBS) are insurers covering a high percentage of the American population. It implies that getting in-networks with them may increase the number of patients you receive.

Then consider reimbursement rates. Other payers can give better rates of a given service. You should also see if their credentialing process is smooth or not. Not all insurers are the same, some will do it sooner than others or even need extra paperwork. You will also be interested to check the fit of the insurance company to your specialty. 

As an example, behavioral health professionals may have an easier time in finding some insurers with enhanced support or networks in their locality. Finally, there is the visibility – insurers that can show their patients a robust provider directory can help find you.

Top National Insurance Providers to Consider

In the U.S. there are several large insurance companies that providers should seek to be credentialed by most of them. Medicare is necessary, in particular in regards to those who deal with older people. It provides secure pay and has a high population. Medicaid also matters, particularly in the case that you intend to provide care to underserved or low-income groups.

Blue Cross Blue Shield (BCBS) is among the biggest and most popular insurers throughout the country. The presence of BCBS plans with big networks and reimbursement exists in many states. Another large payer is UnitedHealthcare (UHC) whose plans are widely used by many employers. Their provider networks are also wide.

Other national leading payers are Aetna, Cigna, and Humana. Such firms cover an expansive region and when a patient panel is provided, it usually generates consistent flow of patients. This CAQH and NPI data are used by most of these insurers so as to accelerate the credentialing process. You also have to do applications by their credentialing offices, or enrollment sites.

Specialty & Regional Payers

Smaller regional insurance companies might also provide benefits to some providers by being credentialed to them. These may involve state specific Medicaid Managed Care Organization (MCOs), local Health Management Organization (HMOs), and mental health or therapy specific networks. In the event that you are practicing in a rural community or a city that has a powerful local plan, in- networking the regional payers may result in an increase in patients.

Specialty payers can also consist of behavioral health carve-outs or niche plans that are related to employer organizations. 

To give an example, behavioral providers may desire to contract with Magellan or Beacon Health, therapists and counselors should explore Employee Assistance Programs (EAPs) or networks with telehealth at its center.

Comparing Payer Credentialing Processes and Time

Insurance companies do not have the same duration of time to complete credentialing. Others are quicker and others are very slow. Such an important payer as Medicare typically spends 60 to 90 days on the processing of an application. You are required to make an application with the PECOS system of which the background, license and working records are checked. The number of providers using this system is numerous, and the regulations are strict on the federal level.

Medicaid and Medicare are not the same since every state has its own program of Medicaid. It implies that the process of credentialing with Medicaid might be different depending on your location. In some states the process is fast whereas in others they may take months. Some states require fingerprinting, background checks or interviews on the spot. These incremental procedures have the effect of taking time.

There are also cases when private payers who use CAQH ProView to collect and confirm your information are Blue Cross Blue Shield (BCBS), UnitedHealthcare (UHC), Aetna, and Cigna. CAQH is an online secure platform that holds your credentials such as license, insurance data, education history. At these companies, you are still expected to make a different application. Here you have to fill their forms and wait to be accepted even though your CAQH profile is active.

How to Prioritize Your Credentialing Order

When you are a new provider, it is quite essential to choose which insurance companies to apply first. One of the first smart moves you can make is to consider asking yourself what insurance companies you should consider getting credentialed with based on your practice goals. It will all depend on who your patients are and what services you provide and where you are situated.

The large payers are usually approached by most providers. Medicare turns out to be at the first spot with the reason being that it serves millions of patients and most of them are old people or disabled patients. Medicaid also plays a very important role when you intend on serving low-income patients. Although Medicaid is expected to consume more time in certain states, it can provide an unending inflow of patients as long as it is given a green light.

Then, it is time to think of major private payers such as Blue Cross Blue Shield, United Healthcare, Aetna, Humana, and Cigna. These plans usually cover employer based plans and are well networked. Being licensed by some of these two or three best private insurers not only allows you to attend more people into your practice but they will make it larger quicker.

Conclusion: Strategy to Maximize Network Access and Revenue

Credentialing is one of the integral parts of successful practice development. Your patient access, income and administrative work load will be determined by what insurance panels you contract. Knowing which insurance companies you should be credentialed with as well as a comprehensive method of selecting them will not only save you time, but will also earn you more money in the long term. 

Credentialing has been made to work in your practice, but one should plan ahead and stay organized. Credentialing is one of the integral parts of successful practice development. Your patient access, income and administrative work load will be determined by what insurance panels you contract. Knowing which insurance companies you should be credentialed with as well as a comprehensive method of selecting them will not only save you time, but will also earn you more money in the long term. 

Credentialing has been made to work in your practice, but one should plan ahead and stay organized.

Frequently Asked Questions (FAQs)

Q Why is the payer credentialing the most necessary?

A: Medicare, Medicaid, and big commercial insurance such as BCBS, UHC, and Aetna are many times critical since they have expansive populations of patients and they provide reliable reimbursement.

Q: Is Medicare credentialing enough?

A: That depends on the type of patients that you serve. Medicare might be sufficient among the elderly. However, major providers require commercial plans to target a wider patient band too.

Q: Do the private payers do automatic credentialing after CAQH?

A: No. Although a large number of these organizations utilize CAQH to check your information, it is important to directly apply to the enrollment network of each insurance organization and complete the enrollment process on the side.

Q: Which should I credit first, local or national insurers?

A: National payers such as Medicare, BCBS, or UHC is a great place to start. After that, there is the addition of regional plans as dictated by the needs of patients and the local networks.

Q: What is payer contract term evaluation?

A: Check out the reimbursement levels, fee scales, claim turnaround span of time and termination provisions. A credentialing service would assist you to bargain or compare contracts.