Insurance Credentialing and Contracting

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Just a few years ago, healthcare professionals considered Insurance enrollment to be optional for building their practice. Today, it is necessary for providers to be in-network with insurance companies. This is partly because more people  have health insurance, and patients desire (even demand) to use their health insurance when seeking healthcare services rather than paying out-of-pocket. Due to the Affordable Care Act,  Americans now have access to affordable health insurance coverage; Millions of people who were previously uninsured will gain coverage.

Due to the increase in membership growth, insurance panels are becoming full — making the process of becoming in-network  more difficult every day, as insurance companies become inundated with enrollment applications. Closed provider panels make the process more challenging and difficult.

Some panels that claim to be “closed” are just being selective about which providers they are adding –  Knowing how to position one’s self, and having credentialing/payor enrollment experts to assist you, can go a long way when it comes to getting into “closed” panels.

Here are some of the benefits of outsourcing your Credentialing and Payor Provider Enrollment needs:

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• outsourcing reduces costs by 30-40%).
• Reduce and control operating costs
• Leverage experts in the field (Don’t miss critical items that could impact your timeline to get enrolled)
• Leverage the efficiency and effectiveness of specialists (Have them work through red tape).
• Eliminate administrative errors
• Eliminate denied claims (Denials can impact your ability to maximize your revenue).
• Optimize billing and collections (Don’t leave money on the table and focus your billing team on what they do best!).
• Expand resources available to your practice (Leverage your personnel based on their strengths and your core competencies).
• Focus on building your practice/agency (Don’t get buried in paperwork and the process of enrollment).
• Focus on patient care required by new healthcare reform (Stay up to date and focus on patient care by eliminating distractions in your work day).
• Gain access to established systems and tools (Credentialing/Provider Enrollment experts will help you get things done the right way and at the right time using the right people to ensure successful enrollment).

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