The credentialing process to be a provider for a PPO plan with an insurance company can be a lengthy and cumbersome process. The best advice is to go in prepared and with your eyes open.
Allow Time for the Process
Getting a provider credentialed can take anywhere from two to six months. It is important for doctors to understand this, especially when purchasing a practice, so they have enough time to complete the credentialing process and are giving accurate estimates to patients. Unfortunately, I have spoken with many doctors who have learned this the hard way.
Read the Contract!
Remember, this is a legal document so make sure all of your bases are covered and that you understand all aspects. Typically a contract is going to favor whoever draws it up, so the practice should take the time to review the document and make sure their needs are being met. There are some questions that need to be answered before the contract is signed.
The credentialing process can be overwhelming. There is a lot of follow-up that needs to be done on behalf of the practice. Someone from the practice should contact the insurance company every 30 days, and it is important to keep a record of who they spoke with and the next step to make sure the process is moving forward. Fortunately, you don’t have to take it on yourself; there are several reputable companies out there that will complete the process for you.
Whether you complete this yourself or hire an outside company to help, make sure your practice’s needs are being addressed and you are comfortable with the final contract before you sign on the dotted line.
Allow Time for the Process
Getting a provider credentialed can take anywhere from two to six months. It is important for doctors to understand this, especially when purchasing a practice, so they have enough time to complete the credentialing process and are giving accurate estimates to patients. Unfortunately, I have spoken with many doctors who have learned this the hard way.
Read the Contract!
Remember, this is a legal document so make sure all of your bases are covered and that you understand all aspects. Typically a contract is going to favor whoever draws it up, so the practice should take the time to review the document and make sure their needs are being met. There are some questions that need to be answered before the contract is signed.
- What is the fee schedule that you are agreeing to accept?
- Are you able to charge your office fee to a patient when the insurance company doesn’t cover that procedure?
- How much notice do you need to give when opting out of the contract?
- What happens when the patient is covered by another insurance plan (coordination of benefits)?
The credentialing process can be overwhelming. There is a lot of follow-up that needs to be done on behalf of the practice. Someone from the practice should contact the insurance company every 30 days, and it is important to keep a record of who they spoke with and the next step to make sure the process is moving forward. Fortunately, you don’t have to take it on yourself; there are several reputable companies out there that will complete the process for you.
Whether you complete this yourself or hire an outside company to help, make sure your practice’s needs are being addressed and you are comfortable with the final contract before you sign on the dotted line.
