Join Insurance Networks: Steps To Take For Coverage

Healthcare providers who want to expand their patient base and make their services more accessible and affordable to patients often consider becoming in-network with insurance companies. This involves contracting with insurance companies to provide healthcare services to their members at negotiated rates. The process of becoming in-network typically involves several steps, including obtaining the necessary credentials and licenses, getting malpractice insurance, and completing applications and negotiations with the desired insurance companies.

Obtain an NPI and other credentials

An important step in becoming in-network with insurance companies is obtaining a National Provider Identifier (NPI). An NPI is a 10-digit number that is a standard, unique, government-issued identifier for individual healthcare providers. It does not expire or change. All healthcare providers who are HIPAA-covered entities or who bill Medicare for their services must have an NPI.

There are two types of NPIs: Individual (Type 1) and Organizational (Type 2). If you are a healthcare provider, you will need to obtain both types of NPIs: one for yourself as an individual and one for your business entity. The NPI will be required prior to submitting any claims or conducting other transactions as specified by HIPAA, such as claims and encounter information, coordination of benefits and premium payment, and referrals and authorizations.

To apply for an NPI, you will need to provide the following information:

• The reason for submitting the application
• Identifying information, including your name, SSN and/or ITIN
• Name of your organization, including EIN
• Mailing and practice location addresses
• Other provider identification numbers you have, if applicable
• 10-digit provider taxonomy code

You can apply for an NPI in three ways:

• Online: Apply through the National Plan and Provider Enumeration System (NPPES)
• By Mail: Complete, sign, and mail a paper NPI Application/Update Form to 7125 Ambassador Road, Suite 100, Windsor Mill, MD, 21244-2751
• Designated CMS contractor: Give permission to an Electronic File Interchange Organization (EFIO) to send application data through a bulk enumeration process

Applying for an NPI is free of charge, and the online application is generally the quickest and easiest way to apply and track the status of your application. After your application is accepted, you will receive your NPI via email. The time it takes to obtain an NPI depends on the volume of applications being processed, the method of application (electronic or paper), and whether the application was complete. A properly completed electronic application could result in an NPI being issued in as little as 10 days, while the paper application process takes approximately 20 business days.

In addition to obtaining an NPI, healthcare providers must also ensure they have the necessary credentials and licenses to practice in the state where they will be providing services. This includes maintaining a current license and any necessary certifications, such as board certification.

Get malpractice insurance

Malpractice insurance is a type of professional liability insurance that covers healthcare professionals against claims of injury and medical negligence. It is essential for healthcare and fitness professionals to carry malpractice insurance to protect themselves from financial ruin in the event of a malpractice claim. This type of insurance can provide coverage for legal expenses and damages that may be awarded to the patient. It is important to note that even the most skilled and careful healthcare providers can make mistakes, and malpractice insurance can offer peace of mind and financial protection.

When applying for malpractice insurance, it is crucial to consider the type of policy that best suits your needs. There are two main types of professional liability coverage: occurrence and claims-made policies. Occurrence policies cover incidents that happen during the policy period, regardless of when the claims are reported. On the other hand, claims-made policies only cover incidents that occur while the policy is in force; once the policy is terminated, coverage ceases to exist. It is worth noting that claims-made policies are generally cheaper initially but can become more expensive over time.

When obtaining malpractice insurance, it is important to ensure that your limits match or exceed the amount listed in the insurance network contract. Additionally, having a copy of the declaration page ready during the application process is advisable. It is also recommended to review the contract carefully and understand the requirements to ensure it aligns with your business or practice needs.

By obtaining malpractice insurance, healthcare providers can protect their professional reputation and credentials. A malpractice suit can jeopardize their standing and potentially lead to license revocation or suspension. Therefore, it is crucial to have adequate coverage to defend against such claims vigorously.

Make a list of insurance companies

Making a list of insurance companies to apply to become in-network with is an important step for healthcare providers. Here are some key considerations and steps to help you create that list:

Geographic Location and Patient Demographics:

Firstly, research which insurance companies are widely accepted or have a strong presence in your area. Different insurance companies have varying levels of coverage in different geographic regions. Consider the patient population you serve and their insurance preferences. For instance, if your patients are primarily elderly, you may want to prioritise getting credentialed with Medicare and Medicaid.

Insurance Plan Types:

Understand the different types of insurance plans offered by companies, such as HMOs, PPOs, and EPOs. Identify which plans are most commonly used by patients in your area. This will help you determine which insurance companies to prioritise.

Reimbursement Rates:

Compare reimbursement rates offered by different insurance companies. You may want to give preference to companies that offer higher reimbursement rates, ensuring a more favourable financial arrangement for your healthcare practice.

Administrative Requirements:

Each insurance company has its own set of administrative requirements for credentialing. Opt for companies with a streamlined and efficient credentialing process to make the application and maintenance of your provider status easier.

National and Regional Presence:

Consider insurance companies with a strong national or regional presence, especially those with insurance as their primary business. These companies are likely to have established networks and a large customer base.

Specific Examples:

While not an exhaustive list, here are some examples of insurance companies to consider, especially if they are prevalent in your area:

• Aetna
• Blue Cross Blue Shield
• Cigna
• United Healthcare
• Humana
• Medicare
• Medicaid
• Multiplan (a major national PPO)
• 21st Century Insurance
• American Automobile Association (AAA)
• American Family Insurance
• American Income Life Insurance Company
• American International Group (AIG)
• Ameriprise Financial
• Amica Mutual Insurance
• Lemonade
• New York Life Insurance Company
• State Farm Insurance
• Transamerica Corporation
• Prudential Financial
• Mutual of Omaha
• GEICO
• Progressive
• Liberty Mutual
• Allstate

Remember to regularly review and update your list of credentialed insurance companies. This ensures that you stay aligned with any changes in patient demographics or reimbursement rates, allowing you to provide accessible and beneficial services to a wide range of patients.

Open a CAQH account

CAQH is a non-profit organisation founded by health insurance companies to streamline healthcare administration. CAQH ProView is a tool used for credentialing and enrolment data exchange. It is a giant database that insurance companies and credentialing companies can pay to access.

To open a CAQH account, you will need to:

• Register with CAQH ProView.
• Complete the online application and review the data.
• Authorise access to the information.
• Verify the data and/or attest to it.
• Upload and submit supporting documents.

The CAQH application process is detailed and requires a lot of information. Basic personal information is required, as well as education and training, specialties and board certifications, practice location information, malpractice insurance information, work history and references, and disclosure and malpractice history.

The CAQH application process can take up to 2 hours to complete, so it is important to be prepared and have all the necessary information and documents ready. This includes IRS Forms (W-9), Drug Enforcement Administration Certificate (DEA), Controlled Dangerous Substances Certificate, state medical license(s), various identification numbers (UPIN, Medicare, Medicaid), and malpractice insurance policies.

Once the application is complete, it is important to regularly update your CAQH profile by quarterly attestations and document updates. This ensures compliance with insurance payers and that your information is accurate and up-to-date.

Contact insurance companies

Once you have completed the CAQH application, it is essential to reach out to the insurance companies you wish to work with. You will be able to review the contract and fee schedule before registering as a provider. Before agreeing to any terms, make sure that you are well-versed in the contract requirements and that they align with the needs of your business or practice.

Occasionally, certain insurance providers may require you to tend to emergency patients within a specific timeframe, have a 24-hour answering service, or prohibit you from delegating certain services. In addition to the CAQH form, you may be required to complete additional forms. It is beneficial to be accurate and attentive to detail to expedite the approval of your application. Any errors, such as a missed signature or an incorrectly filled-out page, could cause significant delays.

It is important to contact each insurance company with which you want to be in-network. You can review the contract and fee schedule before signing up as a provider. Make sure you understand the requirements of the contract and that it fits with your business/practice needs before committing. Sometimes an insurance company may stipulate that you see emergency patients within a specific timeframe, have a 24-hour answering service, or that you cannot delegate certain services to a chiropractic assistant.

To begin the process, contact the network provider services department to inquire about their credentialing process and obtain a credentialing application. Most plans have applications and information on their website. Take time to fully complete your application, listing all service locations for your practice, and include copies of all required documents. Ensure that your CAQH profile is up-to-date with all information, particularly practice location information, and includes copies of all required documents such as licenses, insurance, and board certifications.

Frequently asked questions