Insurance Credentialing & Contracting
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- เผยแพร่เมื่อ 26 ก.ค. 2021
- In this video, I explain the basic steps required to become a participating/in-network provider with medical insurance companies.
Sign up for free Credentialing-Contracting Tracking Spreadsheet: expert-trader-1032.ck.page/bf...
TAKE MY CREDENTIALING AND CONTRACT COURSE: 🌟 Elevate Your Healthcare Career with "Healthcare Credentialing and Contracting: Beginners Course" 🌟
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🔍 Course Overview: Discover the critical importance of credentialing and contracting in the healthcare sector. This comprehensive course is designed to provide you with a solid understanding of the fundamentals that drive the industry forward.
🔥 What You'll Learn: ✅ Credentialing Essentials: Uncover the intricacies of healthcare credentialing, from application processes to compliance requirements. ✅ Contracting Fundamentals: Dive into the world of healthcare contracts, understanding key terms, negotiations, and legal considerations. ✅ Industry Insight: Gain valuable insights into the role of credentialing and contracting in shaping the healthcare landscape.
🎓 Who Should Enroll: Whether you're entering the healthcare field or looking to enhance your understanding of these vital components, this course is tailored for beginners eager to grasp the essentials of healthcare credentialing and contracting.
Don't miss your chance to embark on a transformative learning journey in the healthcare industry. 🚀 Join "Healthcare Credentialing and Contracting: Beginners Course" today!
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Let's shape the future of healthcare together! 🌟 #HealthcareEducation #CredentialingAndContracting #CareerDevelopment Subscribe here to see more of my videos in your feed!
📚 Looking for more in-depth knowledge? Explore our blog for a wealth of articles on Medical Practice Management, Contracting and credentialing, and more: integralclinicsolutions.com/blog
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CAQH ProView: proview.caqh.org/Login/Index?...
NPPES: nppes.cms.hhs.gov/#/
Identity & Access Management System (I&A): nppes.cms.hhs.gov/IAWeb/login.do
CMS Physician Fee Schedule: www.cms.gov/medicare/physicia...
Credentialing Items Checklist PDF, courtesy of STD TAC (see bottom of form for link): drive.google.com/file/d/1rEx-...
ABOUT MY CHANNEL:
Hi! I’m Jennifer. After working in the medical field, in many different capacities over the last 15 years, I have learned much about where medical practice owners go wrong in running their businesses. I created this channel to try and assist medical practice owners from making the same mistakes as their colleagues. I want to see the private practice world of medicine grow and thrive. In my opinion, medicine has become too institutionalized, creating a lot of unnecessary obstacles and demands.
Subscribe here to see more of my videos in your feed! www.youtube.com/@navigatingth...
Sign up for free Credentialing-Contracting Tracking Spreadsheet: expert-trader-1032.ck.page/bf...
📚 Looking for more in-depth knowledge? Explore our blog for a wealth of articles on Medical Practice Management, Contracting and credentialing, and more: integralclinicsolutions.com/blog
Music: www.bensound.com
Photos and Graphics: pixabay.com/
I've just shared this video with my clinic team! Thank you for this super helpful breakdown and the step by step process. The regional differences in healthcare are just so crazy. I'm your neighbor in Portland, OR, and just want to thank you again for this channel. I'm a billing team of one and a CPC, and trying to help our clinicians obtain their actual contracts and fee schedules has been a real learning process!
Thank you for sharing it! I really appreciate it.
Thank you for this series. I just started a new position as a credentialing specialist in the Midwest!
You are welcome! Thank you for watching. Good luck in your new job!
Very informative thank you
If not the best, one of the best video I have seen.
wow, thank you so much! That is a huge compliment. I appreciate you watching and the support!
Great video! Thank you for serving the community through education. Very nicely done!
Thank you so much! I’m glad you find them helpful
Very informative with enough details. Thank you very much.
Glad it was helpful! Thanks for watching!
Super informative. Thanks so much.
Glad it was helpful! Thank you for the support!
Great video. Thank you for sharing this valuable information.
Thank you for the complement and I am happy to help. I appreciate your support.
Thank you for the information Ma'am, i am very happy and understood the Credentialing process by your great explanation.. i am from India working for Evolent Health US based company for credential Process..
Really valuable information. Thanks!
Glad it was helpful! Thank you for watching!
Soooooo helpful! Subscribed! God bless you and can't wait to catch up on more of your videos
I am pleased to hear that and thank you so much for the support. Please let me know if you can think of any topics you would like me talk about in the future. God bless you as well, my dear!
Thank you so much for the video ma'm it's very much helpful for me !
Thank you for watching and the support!! I am glad it is helpful.
i currently work at my State Licensure Board as a licensure analyst and am interested in switching to the credentialing end of things. This was very helpful. thank you.
Best of luck! Thanks for watching!
Wow!! This video was extremely informative! Thank you for this.
Glad it was helpful!
Thank you for this excellent content I can't express how much this helped me. I'm a student and would definitely use this information. Thanks again.😍😍😍
You're very welcome! Please be sure to check-out my other videos and share my videos with your colleagues. Let me know if you ever have further questions or would like to see a video on another topic.
Great information. You clearly know your stuff and love what you do! I am looking forwarding to watching more of your TH-cam videos and learning more from you. Dr. Abdulmalek Sadah
Awesome! Thank you for the support, Doctor. Please let me know if there are any specific topics you would like me to do a video.
super helpful thanks!!
Glad it was helpful! Thank you for watching
It was really helpful, today I'm having an interview wherein I need to explain the steps how to get credentials and your video was very informative. Thank you again
I am so happy that I was able to help you. Good luck in your interview!
Hi thank you for your channel! Do you have a video on steps to follow when terminating a contract with an MCO.
Hi Linda, thank you for your comment. I appreciate your support of my channel. I do not have a video on that topic yet, but I think I will definitely need to add that the list. Please keep checking my channel over the next few weeks to see one come your way! I appreciate the idea. Have a lovely day.
This was very informative, I have a interview for a credential and contracting specialist tomorrow. Thank you
You are very welcome! Hopefully you are able to ask some deep questions to make sure the person really does know what they are doing and are capable of the huge lift. Thank you for watching and supporting my channel! Please let me know if you need anything further by emailing me directly at jennifer@icsolns.net
Love this informational video. Could you make one on credentialing denials? 😊
Great suggestion! I will definitely do one soon. Thanks for the comment and for watching!
This was so helpful. I wish I had found this a year ago.
Thank you for watching and I wish you had too! Please let me know if there are any topics you’d like other videos. Be well!
Thank you for sharing your knowledge! I just opened up a surgery practice 2months ago in CA as out-of-network setting and it’s not working well that we’re thinking to get contracted with big commercial Insurance companies like Anthem, Cigna and Blueshield. Non of them are paying more than 100% Medicare fee schedule. Actually they are about 90% of Medicare fee scheduled at most. Am I going wrong way?
Yes, getting contracted with insurances, especially the national payers like Anthem, Cigna, United Healthcare, Aetna, Medicare, etc. should be better. Your contracts/agreements with them should be higher than what you are getting paid now and help you financially.
Thank you!
You're welcome! Thank you for watching.
Thank you very much! Can we ise a virtyal location initially and then change it?
You are welcome and thank you for watching. It depends because some insurances, like Medicare, might require a walkthrough/visit to the clinic before they agree to allowing a practice to participate with them. Also, updating addresses with insurance companies can be quite delayed by the time they update their records from your notice of change. I don’t recommend that usually, but I know it can be done and works for some people. The big factors are what I mentioned above and also if the insurance will even “let” you do it if they know it’s not your permanent practice address. All insurance companies are different. Good luck!
Thank you so much! How about providing a home address? Because any location you get, you might still beed to change it later
And paying rent without using it is very expensive
this has been so helpful. Subscribed :)
Oh I am so happy to hear this! Thank you!
Hi. Great video. I have heard of medical providers selling a small percentage of their practice to a larger hospital system in order to bill under their tax id and get their (usually) more favorable rates. Do you have any idea of the minimum percentage of your practice you would need to sell in order to access those rates? 10%, 20% etc? Thanks
Hello and thank you for watching! No, unfortunately I am not aware of the percentage. All the private practices I have worked with have refused to be associated with any large corporations. If you are considering this, I would advise to make sure you read the fine print thoroughly and also get an attorney involved. Hopefully you will not have to turnover any control to them, or have to adopt their business and clinical practices. Although they may get reimbursed higher, they may have more requirements as far as MACRA/MIPS to attest to or other federal compliance Definitely look into this as well. Good luck and thanks for the support!
new subscriber here. thanks for this video.. pls continue to make videos like this.
Thanks for the sub! I appreciate the support!
Hi there! Thank you for the information, I hope you can help me with the following question. I'm taking over the credentialing dept at a medical office but I'm new to this, they don't have ANY copies of the contracts, how can we get a copy of the contracts? Do I have to contact all the insurances we're in network with and ask for a copy?
Hi Nicole. Thanks for watching my videos and for the question. Yes, unfortunately, you will have to contact each individual payer to request your group contract (assuming the group is contracted and bill as a group). If each provider is credentialed and contracted with the payer separately (billed individually under their own TIN) then you would need to request the contract for each provider. Most insurances have Provider Relations Representatives assigned to accounts. You can probably get yours by contacting Customer Service and asking for your Provider Relations rep's contact information. You can ask Customer Service if they can also put in a request for the contracts. Often, you will have to send the request via email to a provided email address, which is good for a paper trail. Sometimes the payer portals will provide them to groups by TIN, but not super often in my experience.
On a side note- It is not a good sign they do not have their contracts. That tells me the contracts probably have not been negotiated for a while. Be sure to review the fee schedules and reimbursement from payers to see if it is time to renegotiate. Let me know if you have any more questions. Be well, Jenn
@@navigatingthebusinessofmed8251 Thank you so much for your help!!
You are simply brilliant. I really wish you knew someone in the mental health world to connect me with. I know you are more medical. I’m open to a referral.
You are very kind. I know quite a bit about behavioral health if you want to chat, please email me jennifer@icsolns.net. Thank you for watching and the nice words!
Great video. How does the provider negotiate contracts? Do they call the insurance company and say I would like to negotiate my contract, or is there a specific process?
You have to wait until you receive your contract. If you have things that you want to negotiate, you either reach out to your provider relations representative that you have been assigned and in contact with already, or you call customer service. You let them know you have questions or want to negotiate the contract. If you are communicating via email, it makes it easier and it is all documented too. Sometimes insurances are reluctant to negotiate initial contracts but it is always worth trying. I hope this helps and thanks for watching!
Thank you so much for this video! One question I was wondering if you may help me answer: I am a new graduate PMHNP that has accepted a position at an outpatient private practice with three other providers working in the clinic. The business has an established TaxID, but I wanted to ask, do you think it is best for me to use my SS number or apply for an EIN and use this as my Tax ID rather than the established business tax ID on insurance credentialing applications? Will applications even accept that, or do they want the business Tax ID?
Congratulations! That is exciting. It depends on your compensation and if you’ll be an employee of the practice and paid by them, a salary, or if everyone is responsible for their own income by billing on your own and you just share the practice space and pay towards rent and overheads. If you’re an employee, you would get credentialed and use their TIN and NPI 2 as that would be the contract you’d be billing under and getting reimbursed. Usually they also have someone that does your credentialing for you, so other than providing all the needed documentation for them to do this on your behalf, it should be take care of for you. You have to get credentialed first and then the insurance will affiliate your NPI 1 under that group with their NPI 2 and TIN. I hope this makes sense. If you are just sharing the space and going to be a sole proprietorship with your own business, then I would recommend not using your SSN and getting a TIN and establish a business/group with an NPI 2 for liability and growth potential reasons. Good luck!
You have clarified that beautifully! Thank you so much 🙏@@navigatingthebusinessofmed8251
Great video! I am a Nurse Practitioner in GA, I've been credentialed through a cardiology group that I will be working with PRN. I also, own a paramedical tattooing business - it's my understanding that some insurance companies will pay for 3D areola tattooing. I'm curious, if I've been credentialed via the cardiology group, do i need to go through the same process for my own business? I have my own NPI # & CAQH proview account. How do I proceed? Thank in advance for any advice you can offer.
Hi there! I appreciate you watching. I am not familiar with what insurances cover in regards to 3D areola tattooing, but that is amazing that you offer that! Your credentialing with the cardio office will not carryover to your own business. You are credentialed as a provider under that cardiology group contract, so insurances will only cover services you offer billed under their group TIN and group NPI (NPI 2) and within that scope of practice. The payers may honor your existing credentialing and just require you to credential and contract your group with them. Then, you would associate your individual NPI under the group/business so you can bill for your services offered under that. You will need a TIN/EIN for your business and I would recommend also getting an NPI 2 number so if your business grows, it is easier to add additional practitioners under your group contract with the payers. I hope this makes sense. Let me know if you have more questions. Good luck!
Looking at the list for documents when you have license listed are you talking about professional or practice or both?
Usually the licenses have to with providers, but you will also need the practice licenses, if applicable. Some specialties may require specific licensures to offer particular patient services.
Hi Jennifer, great video, thank you. I'm actually helping my friend set up her own practice , and as part of that was hoping to do the credentialing for her , rather than hiring a credentialing specialist. Do you know if this is even possible , or is it 100% necessary to hiring a specialist? Many Thanks Chantelle
You can totally do it! It is difficult to find a good credentialing company from what other viewers have shared with me. As long as you’re organized, detail oriented, self-motivated and good at communication you should be good to go! Thanks for watching.
@navigatingthebusinessofmed8251 I am Harnish Prajapati working can work for you for your practice credentialing process.
Are there continuing ed and/or certification courses you'd recommend for someone entering this field "cold"? Thank you!
I am actually going to be putting together and offering a credentialing Course within the next few months. Is that what you are looking for or other information and topics as well?
We can not access the video we purchased from Jennifer Blevins-Smith and Navigating the Business Side of Medicine. We have reached out for help multiple times and get no response. I don't know if this is a scam, if not, please help us access the video we purchased.
Hi Beverly it is not a scam. Have you contacted Thinkific directly where you purchased the course? That is where the course is hosted, not on TH-cam. I have had other people experience other challenges and the people there seemed to have been helpful and quick. Here is a link so you can live chat with someone to find your account and help you troubleshoot. www.thinkific.com/contact/
@@navigatingthebusinessofmed8251 Thank you for your help. Yes, we have emailed several time at the thinkific website. I will try again, could you provide me with an email address?
Would a virtual mailbox or virtual office work for the address?? I’ve heard of people having to resubmit their credentialing application and finally being approved after 8 months. I don’t want to pay rent for a space that’s not generating income yet.
That is a good question. You will need to give a practice location on most applications, so they may not process it without a practice location. Every payer is different and it would be a question for each insurance you work with. Just so you know, updating your location and contact information with insurances after finalizing contracts can be a feat all in itself. I would recommend seeing patients to bring-in money during the process and just be very transparent with patients about your status with payers. They may want to either utilize your self-pay option until you are contracted, or sign acknowledgement they will temporarily pay out-of-network prices until you are contracted. Not all patients have out-of-network benefits, so you want to be sure you are very clear when communicating with patients as you schedule them. Not all payers take that long to complete the process so hopefully you would be in-network with at least some companies by the time you start seeing patients. Remember, the tenant improvement and other tasks to open a practice usually take at least a few months before you can start operating and you will have an operating address during that time at least. I hope this helps and good luck!
@@navigatingthebusinessofmed8251 Thanks for your response! Would they accept a home address?
@@NeisiKay You could list a home address and then update it later.Just remember that the address could be used in the insurance directory for your business and it can take a while for insurances to update their records with the new practice address once it is established. You are welcome to email me directly as well at jennifer@icsolns.net if you have more questions. Thanks so much for the support!!
1:23 how do I add new dr with new practice and bring all his insurance companies that he is credentialed with him
Thank you for asking. Are you saying the doctor is starting their own practice? If so, then you would need to request contracts from all insurances for the new practice and then affiliate the provider to the new contract. If they are already credentialed then check with each insurance what they would require to get them affiliated to the new TIN and Group NPI. I offer a credentialing and contracting course you may benefit from- the link to my course is listed in my new video descriptions. Good luck!
Hi Jennifer, is it true if you work as an independent contractor for another health agency that when you leave their practice your possibly already credentialed with that insurance provider?
Hi Jeff and thanks for watching! I believe you may be getting credentialing confused with contracting. If you worked for another entity and they were billing claims out using any of the entity’s tax ID or NPI 2 number on claims, along with your NPI 1 number as the rendering provider, then you are not an independent contractor. If they billed out claims under your own SSN and NPI 1 without any mention of the entity, then you would be an independent contractor. If you were billing with just your own information, then that means you would have a separate contract with the insurances between just yourself and the insurance companies for reimbursement. You would not be listed under the groups’ information and contracts. It is possible to bill out claims with the entity’s information and still be credentialed with the insurance company, even if not an independent contractor. You would need to call the insurance company to find out if they honor that credentialing and if you can get it associated to a different contract if you were to leave that entity. I hope this makes sense. Many times providers will be credentialed with an insurance company so they can be listed under and entities contract and when they leave the insurance company will honor the credentialing because that is based on individual credentials, and then the provider would need to be either associated to a new group contract at a new employer or get their own contract with the insurance company.
Do you offer classes for credentialing and contracts? I’ve worked as an administrative assistant for a hospital for a few years and would like to be more knowledgeable to work in this area of medical practice.
Good day and thanks for asking! Yes, I’m actually in the process of creating a class as we speak. I will be doing an announcement when it is released in hopefully a month or 2. Please email me so I can add you to the newsletter announcement once it is launched: jennifer@icsolns.net
Do you use NPI2 when applying for credentialing with insurance companies? I noticed CAQH only asks for NPI1...
Thank you for your question. NPI 2 is only used with a Group so in an individual provider’s CAQH profile there would be nowhere to add an NPI 2 since it is all based on the provider’s individual information. The NPI 2 number is usually used when trying to get affiliated with an insurance company as a group and also when trying to affiliate credentialed providers with an insurance to an established group. I hope this helps answer your question.
@@navigatingthebusinessofmed8251 Great! Thank you.
I am working to get individually contracted and credentialed with one insurance company, but I am already credentialed and contracted with them at the group level. Can I see my in-person clients at my group practice under their contract - and my virtual clients under my own contract - simultaneously? I am initially looking to just start my own virtual practice, but don’t want to leave the group practice I joined so I can keep seeing my in person clients…
Hi there. Thank you for watching. You will need to get a contract under your own TIN and NPI. If you are working under another group in which you are credentialed, that group has a contract with the insurance company and you are listed as a provider to be able to bill out claims with your NPI and their TIN. If you tried to see patients and bill out without a contract between you and the insurance then it will either get denied for non-participating status or be processed under out-of-network benefits if the patient has those types of benefits on their plan. Long story short is you need to get your own company contract with the insurance company and associate your personal NPI with your company so you can bill as in-network. You do not have to do anything with your employer as you can be affiliated (as a provider) to many different contracts. I hope that makes sense. Good luck!
Thank you so much!@@navigatingthebusinessofmed8251
One provider can be associated/link with how many groups/practices?
One provider can work for multiple different companies and be associated with their individual group contracts. When the claims go out, the specific billing information for the group will be on the Claims themselves in addition to the NPI 1 of the provider rendering the services. The combination of all of those together is what will get the claim paid, so there should not be any confusion if a provider is affiliated with multiple different groups at the same payor.
Hi do you have information on credentialing a facility?
Hi there! Thank for your asking. I have a playlist with step by step instructions for credentialing- please check them out to see if it helps. Basically for facilities you have to contract with the insurance companies and affiliate all credentialed providers with the group. Good luck!
Just began my credentialing process. I just read my first contract. I dont know what I just read. Do you consult or assist with reviewing? It is not clear about reimbursement. Please help.
Hi Cynthia. Thank you for watching! The verbiage in contracts can be quite confusing for sure. Please email me at jennifer@icsolns.net and we can discuss further.
How does the credentialing goes for non skilled home care agency?
Home health has its own set of applications you would complete for each payer, including Medicare. Here is a link from CMS to read more and figure-out what your company would be considered/classified as in order to move forward with the process www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs
im in credentialing of the hospital side however im trying get into provider contracting and I keep getting denied 😢
I’m so sorry to hear that! Keep trying and you’ll persevere! Unfortunately I don’t have any leads for you, but something will turn up! Thank you for watching.
@@navigatingthebusinessofmed8251 thank you so much! I love your videos by the way. very informative and educational. keep them going :)
How do I find a credentialing specialist in AZ?
I would suggest using Google and look for medical billing credentialing specialists in -----, AZ. (whatever city). Please note that a company does not necessarily have to be local to use them for credentialing as everything can be communicated back and forth electronically. As long as they are familiar with the payers in Arizona, then you should be fine. Thank you for the support and for watching my videos!
How do I give BCBS access to my CAQH..Just got my contract
Thank you for watching! Please go to page 125 of the provider user guide found here on this link
www.caqh.org/sites/default/files/solutions/proview/guide/provider-user-guide.pdf
Hello, good video.
Do you speak spanish?
I have a question, but I prefer spanish
I used to be able to speak a little Spanish, but not anymore. I apologize, but please email me and lets try to figure something out so I can assist you further- jennifer@icsolns.net. iGracias!
Had an insurance company trying to pay a fixed rate fee schedule. $50 a visit no matter what treatment................................... BEWARE and read your contracts people.
Yes! So important to read your contracts thoroughly and understand what you are agreeing to if you sign it. Thank you for the feedback.
Can you consult with me for a fee regarding credentaling?
I there. I don’t do Credentialing but you can email me and I can try to assist further jennifer@icsolns.net
Thanks but if you show with animation it will more helpful
Thank you, I will definitely consider that for future videos.