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 include getting credentialed by insurance companies. Selecting the right insurance panels will define your practice’s 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? It will help in making a choice.

Why Payer Selection Matters

Insurance companies do not offer all the benefits equally to providers. Some pay more, while others provide access to larger networks of patients. There are also more convenient and faster ways to obtain credentials. Choosing the right options at the start of the process can save time and reduce stress, making it easier to begin serving patients and getting paid later. That is why both new and experienced providers want to know which insurance companies are the best 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 know, Medicare and Blue Cross Blue Shield (BCBS) are insurers covering a high percentage of the American population. It implies that getting in-network with them may increase the number of patients you receive.

Then consider reimbursement rates. Other payers can give better rates for 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 in checking the fit of the insurance company to your specialty. 

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

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 which are essential. Medicare is especially important for those who work with older adults, as it offers reliable payment and serves a large population. Medicaid also matters, particularly if you plan to provide care to underserved or low-income groups.

Blue Cross Blue Shield (BCBS) is among the biggest and most well-known insurers nationwide. BCBS plans with extensive networks and reimbursement options are present in many states. Another major payer is UnitedHealthcare (UHC), whose plans are widely used by numerous employers, and its provider networks are also extensive.

Other leading national payers include Aetna, Cigna, and Humana. These companies cover large regions, and when a patient panel is established, it typically results in a steady stream of patients. Most of these insurers use CAQH and NPI data to streamline the credentialing process. You will also need to submit applications through their credentialing offices or enrollment sites.

Specialty & Regional Payers

Smaller regional insurance companies might also offer benefits to some providers by being credentialed with them. These could include state-specific Medicaid Managed Care Organizations (MCOs), local Health Management Organizations (HMOs), and networks focused on mental health or therapy. If you are practicing in a rural community or a city with a strong local plan, in-networking with regional payers can boost your patient volume. Specialty payers might also include behavioral health carve-outs or niche plans linked to employer groups. For example, behavioral providers may want to contract with Magellan or Beacon Health, while therapists and counselors should explore Employee Assistance Programs (EAPs) or networks that offer telehealth options.

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. A payer as important as Medicare typically spends 60 to 90 days processing an application. You are required to make an application with the PECOS system, where the background, license, and working records are checked. The number of providers using this system is numerous, and the regulations are strict at the federal level.

Medicaid and Medicare are not the same since every state has its own Medicaid program. 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 it may take months. Some states require fingerprinting, background checks, or on-the-spot interviews. 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, and education history. At these companies, you are still expected to make a different application. Here, you have to fill out 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 essential to choose which insurance companies to apply to 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, what services you provide, and where you are situated.

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 workload will be determined by what insurance panels you contract with. 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 and stay organized. Credentialing is one of the integral parts of successful practice development. Your patient access, income, and administrative workload will be determined by what insurance panels you contract with. 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 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 often 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 for 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 are a great place to start. Following this, regional plans are added to address the needs of patients and local networks.

Q: What is payer contract term evaluation?

A: Check out the reimbursement levels, fee scales, claim turnaround period, and termination provisions. A credentialing service would assist you in bargaining or comparing contracts.