When you join an insurance panel for the first time, you’ll go through a process called credentialing. It is during this process that your contracted rate is determined. A contracted rate—also known as a negotiated rate, an allowed amount, or an agreed upon amount—refers to the amount an insurance payer agrees to reimburse for your services.
To become an in-network provider and begin billing insurance, you must first apply online by visiting the insurance company’s website. After you apply, it’s important that you fill out a Council for Affordable Quality Healthcare (CAQH) Pro View Application. The CAQH is where you will self-report your education, training, and experience. It may seem like a long and tedious application, but unless your information changes, you will only have to fill this out once.
If you’re not sure which insurance companies will be the most valuable for you to partner with, think about the population you are most interested in servicing and also consider the dominant employers in your area.
Do some research online or reach out to a colleague to find out what insurance they offer their employees. If a large percentage of your surrounding area is insured through Medicare or Medicaid, consider joining those panels. We also recommend researching which insurance payers have the most competitive reimbursement rates in your area.
To verify your client’s insurance benefits, you’ll need to collect your client’s name, birthdate, and address, as well as the same information for the subscriber. Your client may be the subscriber, but it also may be their spouse or family member. You’ll also need the plan name, member ID number, and phone number for providers.
To begin filing claims, you’ll need to understand some basics of billing and coding. ICD-10 codes are used to diagnose a client’s condition, while CPT codes are service codes that describe the procedure you performed.
Download this free ebook today to learn more about the basics of insurance billing, how to get through credentialing, and how to successfully file claims.