When you join an insurance panel for the first time to begin billing insurance, 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 for an insurance company, 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.
All insurance companies will use this application to verify your qualifications. This entire process is slow, and persistent follow-up is key. It is important to document every interaction that you have with the insurance company, specifically the insurance representative’s name that you spoke with and a reference number for the call. Be diligent and follow up at least twice a month.
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.
One mistake providers that are new to insurance make is enrolling in too many panels right from the start. We recommend starting out on the panel of only 1 or 2 insurance companies so you can have an idea of how much time and work you will need to commit to billing.
To learn more about verifying client benefits, how to file an appeal, and the basics of insurance billing and coding, download our free ebook today.