No longer just an option for general medical practices and specialists, today’s otolaryngology clinics depend on credentialing to provide their patients with the options they need to afford the best care possible. Credentialing is the process of becoming enrolled with an insurance company, to become part of the preferred provider network. As the healthcare industry changes and evolves, more patients are looking for preferred providers for specialty services, such as Ear, Nose and Throat (ENT) physicians and clinics.
There are many advantages to outsourcing credentialing services to healthcare consulting companies. Fast and accurate credentialing and recredentialing services, can help you to keep your focus on providing top quality services to your patients, as well as maintaining otolaryngology management, billing and coding. Just a few years ago, patients did not expect all healthcare providers to accept their insurance, but with today’s rising healthcare premium costs and increased need for specialists, credentialing is more important than ever before.
Becoming a Preferred Provider
As healthcare insurance needs change, the requirements for medical practices much change as well. More physicians, healthcare providers, clinics and specialists are becoming what is known as a preferred provider, which requires being in network or credentialed with the insurance companies. As a result, credentialing services have also become more popular with physicians. Making sure that you hire healthcare consulting companies that can provide you with fast and accurate credentialing is extremely important. Any delays in credentialing or recredentialing services, as they are needed, can cause major problems for your practice.
Today’s patients are well aware of the need for a physician or clinic to be in network. Some won’t even consider going to a recommended specialist of they are not a preferred provider. In order to keep up with the competition and provide services to all of the patients who need your care, it just as important to focus on proper credentialing services as it is otolaryngology management, billing and coding. If you are not in network with a possible new patient’s health insurance plan, chances are good that you could lose that patient to another local practice. At the end of the day a practice is a business, so it makes good business sense to ensure that all patients who get referred to you stay with you because you are a preferred provider.
What is Credentialing?
Sometimes referred to as medical credentialing, provider enrollment or insurance credentialing, this is the process that is used to help a physician or clinic become affiliated with an insurance company as a preferred medical provider. Once you become a preferred provider, you are able to accept third-party reimbursements for your services from the insurance company. Credentialing services help physicians and practices to get through the “red tape” associated with the credentialing process, ensuring that everything is submitted accurately and in a timely manner.
Recredentialing services are done to continue the relationship between the physician or clinic and the insurance company to provide continuous and uninterrupted care to your patients. A lot of work goes into credentialing services, so many physicians pass off this task to their otolaryngology management billing and coding departments. Unfortunately, just one small mistake can cause your application to be denied. Some companies require applications that are 30 or more pages long and require a lot of follow-up and time spent answering questions. Your best bet is to hire trusted healthcare consulting companies like MD Pro Solutions to take care of this process for you. We offer both credentialing and recredentialing services to our clients.
Top Insurance Companies in the United States
While you might not be able to afford credentialing services for each and every insurance company that is available, you can at least apply to the biggest companies, which will allow you to provide services to the largest number of patients in your area. You can add other companies to your request for fast and accurate credentialing as you see a need for them, helping to reduce your upfront cost, especially for new or small practices on a budget.
The top insurance companies in the United States, according to a survey conducted by Forbes, include UnitedHealth Group, Anthem, Aetna, Cigna and Humana. Other companies that you hear about frequently, with regard to market share and success, include Kaiser Foundations, Wellpoint, Inc., Health Care Service Corporation (HCSC), Highmark and Blue Cross/Blue Shield.
Contact MD Pro Solutions for Credentialing Services
If you are in need of professional, fast and accurate credentialing or recredentialing services, contact our team at MD Pro Solutions by calling 508-946-1665. Our team specializes in otolaryngology management, billing and coding. We can help you with a wide variety of professional services, including credentialing services, outsourcing solutions, training, education, and much more. Give us a call today and learn more about what healthcare consulting companies can do for you.