How do i find out what insurance companies i am credentialed with

Q: Can providers see patients before payer credentialing is done?

New providers often dont realize that credentialing must be completed before you can see patients. Delays in the initial credentialing process can prevent you from working, from being paid by insurance companies, or both.

Here is a recent question we received about independent and group provider credentialing (enjoy!):

Table of Contents Show

How do you know who you are credentialed with?
What does it mean to be credentialed with an insurance company?
How long is Caqh credentialing?
Can providers see patients before payer credentialing is done?

Question:

I currently work for a group practice and have several insurances that I accept through that group practice. I was wondering if it is possible to take those contracts or credentials and work privately. Also, how long will this process take? If I’m credentialed, can I just start up my own practice? In general, what is the difference between being credentialed and contracted? I just want to make sure I have my terminology correct. Can your company assist me with this? Thanks!

Answer:

When someone works for a group practice, they are sometimes “independently credentialed,” and just connected with the company’s tax ID number (via a W9 form) and the company’s address. Changing the provider credentialing situation so that the provider can start billing from their own practice (and billing from their own office) involves contacting the insurance companies, submitting a new w9, and submitting a change of address form. It generally takes about 60 days for this change to take effect.

On the other hand, sometimes when a provider is credentialed, they are credentialed as a member of a group—specifically through their employer’s tax id and insurance contact. In this instance, the provider would need to begin their credentialing from square one. This takes on average about 120 days. And to answer your question about “Contracted vs Credentialed”, these terms are interchangeable as they mean the same thing. 🙂

We hope this answer helps! If you think we can be of additional help in the future, reach us anytime directly at 1-855-664-5154. A credentialing specialist will answer your call and tell you all you need to know about the credentialing process. Additionally, if interested, they can detail our services for you: of which include completing this process for you. That’s right, if you’ve had enough of this lengthy, strenuous process then we will happily take the reins. Our team of experts know what to do to get you on the insurance panels you desire. And they want to take this off your hands so you can get back to your rightful focus: helping your customers.

Congratulations! You’re expanding your practice or going out on your own. Whichever route you’ve chosen is one that is likely both exciting and a bit scary.

So, now that you’ve made this decision (or still thinking about it ?) you are probably wondering: What do I do about accepting insurance? Do I need to change anything? Where do I start?

No worries, we will break down the steps for you. Also, feel free to join us in the Mastering insurance Facebook group if you aren’t already a member. We talk about these things all the time.

Leaving a group or organization:

So, lets start with the scenario that you are leaving an organization and want to know if you can take your credentialing with you. The short answer is: maybe. I know, right?! It’s not as cut and dry as we would like. Whether you will be considered in network (INN) at your new practice will depend on:

How you’re currently credentialing matters. Here are the common scenarios.

So, if you are credentialing under a group contract that is affiliated with another agency you will likely have to start the credentialing process for your business. The good news is being an existing INN provider typically reduces your credentialing processing time.

If you are credentialing as an individual under the existing group, you will likely need to do a demographic update. Some insurance companies have a specific form they want you to complete, or they want you to go on their provider portal and electronically submit this update. If an insurance company tells you to submit a demographic update via fax on your letterhead feel free to grab our templates (There’s a $50 off code inside the Mastering Insurance FB community).

How do I find out how I’m currently credentialed?

This is another question that naturally comes up when one begins this process. One approach is to ask the person who handles credentialing at your existing organization. This isn’t always an option, so the alternative approach is to contact the insurance companies directly. You want to contact the Credentialing department (also referred to as Provider Relations) and ask for a copy of your contract. You can also ask them how to update your credentialing from group to solo. Make sure you write down the instructions and ask for a reference number for the call.

You will need an NPI-1, NPI-2 (for your own company), EIN, and a W-9. These documents are commonly requested anytime you are changing your credentialing address. So gather these documents so you’re ready to go. If you’re not sure why you need a both an NPI-1 and NPI-2 check out this blog post that explains it in detail.

You’re a solo practice expanding to a group:

Again, congratulations! This is super exciting for you, your team and the clients your practice will serve. Some insurance companies will allow you to switch your contract from solo to group.

There are two types of group contracts that are typically issued:

A contract in your Businesses name with the EIN, NPI-2 as billing providers and you are the rendering provider (NPI-1)
A true group contract where your business is contracted for services. This contract is a bit harder to obtain and may not be available unless you meet certain criteria. Most of us have the contracts listed in #1 and its typically all we need.

Here’s what you want to know when you’re seeking a group contract:

You want to know whether the insurance company will issue a group contract to your organization. You want to tell them the type of providers you have, how many and what services you offer.
You want the contract billing and payments to be issued to the group NPI-2 and EIN and if these can be added to your existing credentialing contract (best case scenario as far as processing time)
Inquire about what they require in order to add additional clinicians to your group. The answer to this question typically highlights whether you have a true group contract. True group contracts typically only require that you add new clinicians to your group roster. Other group contracts typically require credentialing, although the processing time is shorter than solo contracting.

Benefits of asking for a group contract even when it’s just you?

Easier to add clinicians later on
Leverage your group status to negotiate higher rates
Leverage your group status to negotiate better contracting terms
You’re prepared for expansion

If you would like additional support we are here to help. Join us in the FB group, check out our courses. We teach you how to Master the insurance credentialing and billing process.

We know that sometimes you want it off your plate. We can handle the credentialing for you. Request a quote here

If you haven’t downloaded our checklists you can grab them here:

Credentialing Checklist

Billing Checklist

Starting a Private Practice Checklist

EHR: TherapyNotes Free for 3 Months: Code is in the MIMH FB Group

How do you know who you are credentialed with?

Calling the Insurance Companies If there is any question about whether or not you are credentialed, it is best to call the insurance company directly to verify.

What does it mean to be credentialed with an insurance company?

- Insurance credentialing is the process of becoming affiliated with insurance companies to ensure health. care providers can accept third party reimbursement. - A credentialing process is utilized by health care facilities as part of its process to allow practitioners to.

How long is Caqh credentialing?

CAQH will review the application and documents for accuracy and completeness. Documents typically take 2-5 days for CAQH's approval. Required documents must be successfully uploaded and approved by CAQH before the CAQH ProView profile is considered complete and accessible to HSCSN.

Can providers see patients before payer credentialing is done?

New providers often don't realize that credentialing must be completed before you can see patients. Delays in the initial credentialing process can prevent you from working, from being paid by insurance companies, or both.