Physician Credentialing & Provider Enrollment
Provider Enrollment and How to Accomplish It
In getting an individual healthcare provider a part as member of a commercial or public insurance network, it is required that you undergo a credentialing and contracting process. There are two specific but related activities for this process. One is that you submit the providers Curriculum Vitae and this has to be verified, then the offer, negotiation and signing of a formal agreement that outlines the different conditions of the business. A healthcare provider is required by each insurance entity to follow its own process, procedures and information, and this should be submitted in order to be successfully enrolled in the network of the payor. Learn more about Payor Rate Negotiations, go here.
There is what is called the first phase called the introduction. In this phase, the payor is notified by the provider that it is interested to join their network. A phone call is usually taken as a first step to the payor development office to check what is the exact process, what are the information and application needed, the time frame that is involved to complete the procedure, and this starts the flow of paperwork involved. Find out for further details on Provider Enrollment right here.
The next step is called credentialing phase considered as an intensive phase.This is because the payor would like to know everything necessary to know about those who would like to be a part of their network. The normal kinds of information that are required are about the personal information, history of employment, the educational background, professional or practice information, and checking whether or not the provider has faced any legal or license issues that read law suits or revocations. When all information has been gathered and forwarded, these will undergo the process of verification to be done by the payor or their representative. Know that the verification process covers to make sure that all information asked on the application are filled in.
Once everything checks out and the payor gives a conclusion that an enrolment can be offered to the provider, there is still the final phase of provider enrolment which is the contracting phase that has to be started. This means the payor then sends the contract together with the proposed reimbursement rates to the provider and the provider has to review these carefully. This is the time when you can request changes or alterations in the initial phase of the contract. Yes you can negotiate but just be aware that it will again go through another approval process that could delay time to your purpose. Note that it takes about 60 days to a maximum of 8 months for the process to complete from start to end, and during this period there should be constant follow-ups with the payor in every step of the process. Take a look at this link https://en.wikipedia.org/wiki/Credentialing for more information.