Credentialing Enrollment
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CREDENTIALING AND PROVIDER ENROLLMENT
Both for a private practice or a larger healthcare facility, credentialing is the crucial first step before seeing patients. However, getting credentialed can be a time-consuming and frustrating process, even when you know which payor you need to be credentialed with. That’s where Umulisa Health comes in to intervene, reducing the time and effort required to complete the process.
What We Offer
WHAT IS THE CREDENTIALING PROCESS
Network research: Our network research identifies ideal insurances for your location and specialty. With expertise in Medicare, Medicaid Managed Care plans, and commercial payers, our team proactively contacts them for enrollment details, ensuring efficient processing.
Application Filing: We offer a thorough checklist for insurance applications. After receiving your details, our team swiftly submits contract applications. With our expertise, we ensure flawless submissions, leading to quick approval and a streamlined contracting process, saving you time.
Application Follow up: Our team stays on top of the submitted applications by following up every two weeks to ensure that the insurances are actively processing the applications and that no additional information is being requested. Additionally, you will receive reports with updates from the insurance companies every 15 calendar days.
Contract negotiation plays a crucial role in securing favorable terms with payors. Providers rely on skilled negotiators to advocate for competitive reimbursement rates and favorable terms, ensuring optimal financial outcomes for their practice. Effective negotiation can lead to increased revenue and long-term success in the healthcare industry.
Contracting is a critical step in the credentialing process, involving negotiations with payors to secure favorable reimbursement rates and terms. Providers must navigate complex contracts to ensure fair compensation for services rendered. Expert assistance can streamline this process, ensuring maximum revenue potential and financial stability for the practice.
Which Plans Should you Consider?
As a healthcare provider, one of the crucial steps in expanding your practice and reaching more patients is credentialing with various insurance companies. However, with a multitude of insurers out there, it can be challenging to determine which ones are worth considering. In this guide, we’ll explore some of the top insurance companies to consider when credentialing, including Medicare, Medicaid, and a range of private insurers.
Let’s start with the basics – Medicare and Medicaid. These federal programs provide health coverage to millions of Americans, including seniors, individuals with disabilities, and low-income individuals and families. Credentialing with Medicare and Medicaid opens the door to serving these populations and accessing reimbursement for your services.
Private Insurers
In addition to Medicare and Medicaid, credentialing with private insurers can significantly expand your patient base and revenue opportunities. Here are some top private insurers to consider:
1. Aetna: Aetna offers a wide range of health insurance products and services, including medical, dental, pharmacy, and behavioral health coverage.
2. Cigna: Cigna is a global health service company offering insurance products and related services, including medical, dental, behavioral health, pharmacy, and vision care benefits.
3. Blue Cross Blue Shield: Blue Cross Blue Shield companies provide health insurance coverage to millions of Americans across the country. Credentialing with Blue Cross Blue Shield opens doors to a vast network of providers and patients.
4. United Healthcare: United Healthcare is a leading health insurance provider offering a range of health benefits and services, including medical, dental, vision, and prescription drug coverage.
5. Humana: Humana offers a variety of health insurance products and services, including medical, dental, vision, pharmacy, and wellness programs.
6. Tricare: Tricare provides health coverage to members of the military, veterans, and their families. Credentialing with Tricare allows you to serve this important patient population.
7. Anthem: Anthem is one of the largest health insurance companies in the United States, offering a range of health plans for individuals, families, and employers.
8. Highmark: Highmark is a diversified health and wellness company offering a variety of health insurance products and services, including medical, dental, vision, and prescription drug coverage.
9. Kaiser Permanente: Kaiser Permanente is an integrated managed care consortium, providing healthcare services to members in several states. Credentialing with Kaiser Permanente allows you to access their network of providers and patients.
10. Molina Healthcare: Molina Healthcare is a managed care company focused on providing health insurance to low-income individuals and families. Credentialing with Molina Healthcare allows you to serve this underserved population.
11. Regence: Regence is a nonprofit health insurance company offering a range of health plans and services, including medical, dental, vision, and prescription drug coverage.
12. Wellcare: Wellcare is a managed care company specializing in providing health insurance to Medicare and Medicaid beneficiaries. Credentialing with Wellcare allows you to serve these populations and access reimbursement for your services.
13. Centene: Centene is a diversified multinational healthcare enterprise that provides a variety of programs and services, including Medicaid, Medicare, and commercial health plans.
Credentialing with a diverse range of insurance companies opens up opportunities to serve different patient populations and maximize revenue potential for your practice. Whether you’re considering Medicare, Medicaid, or private insurers like Aetna, Cigna, or Blue Cross Blue Shield, each credentialing opportunity brings unique benefits and opportunities for growth. By carefully selecting the insurers that align with your practice’s goals and patient demographics, you can position yourself for success in today’s dynamic healthcare landscape.
Credentialing Checklist
1. Obtain Your NPI: Start by obtaining your National Provider Identifier (NPI), a unique ID for healthcare providers. Consider an NPI Type 2 for private practices.
2. Ensure a Valid Licensing: Verify your license is current and valid for your specialty and state to comply with regulations.
3. Obtain a DEA License: If prescribing controlled substances, get a DEA license to comply with federal regulations.
4. Secure a Malpractice Coverage: Protect your practice with adequate malpractice insurance, valid for over six months.
5. Set Up Your CAQH Account: Streamline credentialing by creating a CAQH profile, used by insurers like Aetna and Blue Cross Blue Shield.
6. Prepare a Release of Information: Ensure transparency by preparing a release of information for potential payors.
The process can span several months, and certain insurers may not be accepting new providers. However, Umulisa Health has the expertise to expedite the enrollment, ensuring a faster credentialing process for you.
Contact us for any questions related to credentialing and enrollment services.
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