Not so long ago, healthcare professionals considered credentialing and contracting with insurance companies to be optional for building their practice. Compared to previous years, more patients have some type of a health insurance coverage, and a very small percentage of that patient population can afford paying the high out-of- pocket expenses for services from a provider that is not in network with their insurance carrier.
Simultaneously, insurance companies became inundated with network enrollment applications resulting in insurance networks becoming "closed" or just being selective about which providers they are adding. Due to that fact, the process necessary to become an in-network provider is getting more difficult every day.
What is Credentialing? It is a process used to evaluate the qualifications and practice history of a physician. This process includes a review of a physician's completed education, training, residency, licenses and certifications issued by a board in the physician's area of specialty. This process is conducted before the physician is permitted to join the network. Once the physician and the practice are invited to accept an in-network status, the insurance company issues the contract which under certain circumstances can be negotiated for more favorable terms.
What is Re-Credentialing? As part of the contract agreement, the insurance company contacts the provider to review providers' and practices' credentials on an ongoing basis, following standards established by states, regulatory bodies and accrediting organizations, such as the National Committee for Quality Assurance (NCQA).
Elite Medical Business Solutions provides contracting and insurance credentialing services to providers, their practices and hospitals across the country, and have been doing so for nearly 15 years in these settings. We take care of everything from start to finish and keep you from spinning your wheels on the telephone for hours and hours each day. Our credentialing specialists understand how to work with the insurance companies and understand what each insurance contract means to your bottom line.
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