Medical Credentaling Service - Get on Insurance Panels, Provider Enrollment
What is Medical Credentialing and Why is it Important?
Medical Credentialing is the process of becoming affiliated with insurance companies so that your patients or clients can use their insurance to pay for your services, and so you—the healthcare provider—can accept third party reimbursement. In today’s medical marketplace, being able to accept potential patients’ insurance plans is crucial for the success of healthcare practices big and small. Put simply, if potential patients can’t use their insurance plans at your practice—be it a family medical clinic, a counseling office, chiropractic, dental, an optometrist’s office, etc.—patients are likely to “vote with their feet” and find a competing provider who will.
Unfortunately, medical credentialing can be an unwelcome distraction from providing quality care to patients–but it doesn’t need to be.
Patients Want to Use their Insurance
About twenty years ago, physicians and healthcare professionals alike still considered medical credentialing (getting in insurance networks) to be optional for building a medical practice. In contract, today it’s become more necessary than ever for providers to be networked with insurance companies. This is partially because more people in the U.S. have health insurance than ever before. And in many ways, those health insurance plans cover more than ever before. One can go to healthcare.gov to read that previously not covered pre-existing conditions are now, by law, necessarily covered. One can also see that insurance plans also have “mental health parity” which means insurance plans cover services provided by mental health counseling and psychiatric practices.
One notable way that insurance plans are more limited than in years past in the absence of “out-of-network” benefits. When one has out of network benefits one doesn’t need to choose a provider who is in network. Instead, the patient can select any qualified provider and later file for reimbursement to his/her insurance company. Today, in contrast to years past, very few insurance plans have out-of-network benefits, and then they do (again, very rare), there are significant financial penalties to the patient for choosing an out of network provider. Hence, patients look in network to find a provider—sometimes the first place they look for a doctor or healthcare provider near them is their insurance plans preferred provider list.
Insurance Plans: Covering more Services than Ever
Medical credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include mental health and behavioral health parity, as well as fewer restrictions on pre-existing conditions and the coverage of supplemental services. These services include physical therapy, massage therapy, acupuncture and others.
However, the cost of health insurance in the United States has increased accordingly. Persons invest heavily into their health insurance plans, and you better believe when they need healthcare services—be it general medical care, emergency medical care, dental, chiropractic, optometry, or mental health services, or anything—patients desire (even demand) to use their health insurance plans when seeking those healthcare services.
Insurance Panels: Getting Full and Closing
Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.
Help Getting on Insurance Panels
If you're looking for a medical credentialing service that can take the burden of getting on insurance panels off of your plate, consider us at Credentialing.com. We’ve helped thousands of providers and practices get credentialed and we'd love to talk with you about our trusted and effective credentialing service.
Please feel free to call us at: 1-855-664-5154.