Insurance credentialing can be described as the willingness of various health care services and professionals to participate in providing care in association with the co-opted insurance providers. Insurance credentialing providers often encourage clients to become affiliated with insurance companies in order for the service provider to accept third-party reimbursements. This is essential because it makes the payer have confidence in the services offered by the client. The entities that can apply for credentialing include:
• Independent Diagnostic Testing Facilities
• Pharmacies
• Surgeons
• Home Health Agency
• Transportation companies
• Laboratories
• Physician Groups
• Urgent Care Centers
Benefits of Insurance Credentialing
In recent years, insurance credentialing has gained wide acceptance. This factor is attributed the high number of patients with health insurance coverage and the fact that most patients prefer using their insurance policy to cover medical bills. Insurance credentialing is also growing because of the changing scope of health insurance plans. Many plans now accept fewer restrictions on pre-existing conditions, in addition to providing cover to many hitherto uncovered conditions such as physical therapy and mental and behavioral healthcare services.
Every state in the US has its own regulations when it comes to insurance credentialing. However, most insurance panels require candidates to apply for credentialing once they are licensed. New changes in the Affordable Care Act mean every American now has access to affordable health insurance, a move that has given new importance to insurance credentialing. Besides reimbursements, the other key benefits of insurance credentialing include:
Patient Quality Reporting System (PQRS) – The provider can save a client’s practice from exposure to negative reporting penalties. It also helps the client conform to all the set regulatory and compliance standards that are crucial for government reporting. Clients also get to enjoy various incentives by getting accurate and timely payments.
Help with Transition – The enforcement of the Affordable Care Act (ACA) has brought with it changes that will affect the way health care facilities are managed in view of the expected rise in patient numbers. A credentialing provider is best placed to help clients go through the transition period, stress free.
Council for Affordable Quality Healthcare (CAQH) – The provider collaborates with various non-profit insurers to streamline the client’s revenue cycle.
Data Collection – Credentialing services will ensure the client stays updated when it comes to patient data collection and utilization. This can go a long way to enhance the provider’s service delivery and revenue strategies.
Credentialing Services
One company that is at the forefront of providing insurance credentialing services is InNet. The company understands the credentialing process as well as the rules and regulations of multiple insurance companies. This advantage gives InNet, the capacity to offer quick, positive results.