Credentialing and Contracting with a health plan are two important steps for every healthcare provider to ensure they meet the necessary requirements to practice.
Credentialing process includes background check on provider’s education, identity, licensing, and other criteria that a health plan needs to verify before publishing the provider details into the directories helping their customers (patients) find their preferred provider.
Contracting is followed by Credentialing process. that obligates the provider in acceptance of their allowed rates and other terms they propose to sign in an agreement.
Many providers have a bitter experience during the credentialing tasks handled for their practice. Comprehensive paper work with long turn around time are the main concerns from providers.
Challenges in the credentialing process
No Proper Planning
Credentialing Initiation work delays even in minutes can sometimes bring an adverse impact on the TAT (Turnaround Time) of the application approvals as most the Insurances process the applications on Queue basis. Credentialing process should always be well planned, timely initiated and well-implemented.
Inaccurate or Incomplete information.
Typo errors while filling information on provider credentials, license IDs These mistakes cause delays and sometimes application rejections too specially while working on Medicare and Medicaid applications.
All supporting documentation needs to be enclosed to the credentialing application: missing any of the enclosures messes up the turnaround time on approval process.
Poor Document Management
Mishandling important documents can cause confusion in the credentialing application process; one should be easily find the related documents as and when required to work with Insurances.
Poor / Lack of follow-up on Tracking the application status
There is a scope of application to get stuck or delayed due to some. additional information.
Delay or No follow ups in tracking the application status shall result in loss of revenue if provider already starts seeing patients with awaiting updates from Insurances.
Team at Life Line Billing Solutions have great expertise in handling this time taking complex process for you so, you may focus on more important areas of your practice.
Our strategies in streamlining the credentialing process
Digital technology has simplified healthcare credentialing process. Our highly experienced professionals use such technology.
Effective communication with providers
Our dedicated credentialing coordinators assigned to the provider will make our clients aware of their responsibilities in providing all the necessary information on work history, all disclosure questions on license and malpractice which is very important in handling the credentialing application process.
Compliance with state regulations
Our Team sets a work flow in compliance to the provider practicing state. We stay up-to-date with regulatory changes and the associated paper work.
Well organized workflow
We prioritize the payers according to the payer mix data we get from our clients; before submitting the applications to the health plans, we do the validation of application data and provider licenses to avoid any delays that could possibly happen when any of the data is incorrect or incomplete.
Pro-active approach is essential in credentialing process.
Secure data management
Provider Credentialing Data needs to be managed efficiently and we facilitate this through our secure document management system that stores all the data with encrypted passwords and only authenticated office personnel can view and send any needed information to the health plans as and when needed during the credentialing, re-credentialing or revalidation times.
Credentialing is the critical aspect of healthcare management. our simplified solutions make this process hassle free so that, you could focus more on patient care.