Starting a new practice, adding a new provider, changing practice locations, or breaking away from a group to become solo, all require enrolling with insurance companies in order to become a participating provider with that insurer. Patients are much more likely to seek treatment from providers who participate with their insurance plan. Thus, a benefit for becoming a participating provider is the opportunity to obtain new patients for your practice. Filling out enrollment, and re-enrollment applications for insurance companies, hospital staff privileges, and malpractice carriers is tedious and time-consuming. Application processing, tracking and diligent follow-up is difficult to manage, and many providers don’t realize that a successful provider enrollment process needs to be just as important as any other aspect of running a successful practice. By reducing provider enrollment timeframes, practices can generate incremental revenue. Using a third-party that specializes in enrollment, such as PracticeWorx, can speed up the process by ensuring accuracy and efficiency of each application submittal, while costing far less than hiring someone internally to perform these functions.
In the simplest of sense, credentials management is the process by which all of a provider’s credentials (ie. licensure and certification, staff privileges, insurance participation, continuing education) are kept up-to-date and accurate in a secure and organizational manner. Credentialing is the verification process by which insurance networks, healthcare organizations and hospitals utilize and evaluate documentation regarding a medical provider’s experience, training, work history, licensure, regulatory compliance record and malpractice history in order to permit that provider to participate in their network or treat patients at their hospital or facility. Re-credentialing typically occurs every two to three years, proving that it is more than just paperwork. Credentialing and re-credentialing is a complex and ongoing process that can prevent or delay provider reimbursement if not completed successfully. Credentialing can be a tedious process, with seemingly endless paperwork. Outsourcing to a specialist, such as PracticeWorx, is typically less expensive and more efficient than hiring or assigning a staff member to maintain this essential function. We think you will find it doesn’t have to be a painful experience. You see patients, leave the paperwork to us.
|Alabama||Hawaii||Massachusetts||New Mexico||South Dakota|
|Florida||Maine||New Hampshire||Rhode Island||Wisconsin|
|Georgia||Maryland||New Jersey||South Carolina||Wyoming|
|Aetna||Blue Shield||Humana||Medicare HMOs||Principal|
|Amerigroup||Champus||Great West||Medicaid HMOs||TriCare|
Currently, we have chosen to specialize in provider enrollment and credentialing services. This allows us to provide highly skilled support for your practice. PracticeWorx streamlines the provider enrollment and credentialing process so you can focus on what matters, your patients.
Much of the estimated time of completion for new provider enrollment depends on a number of factors, including:
Many of these individual factors will directly influence how quickly you are able to complete the enrollment process. INSERT link to enrollment section/process section
Most provider enrollment needs can be completed within 4 to 8 months, circumstances permitting.
The choice to see patients prior to completing the enrollment process is at the choice of the provider. However, one important thing to keep in mind is that you will have to bill your patients as a non-participating provider. This means the patient is subject to 100% of your fee. The risks and benefits of this are best determined on an individual, case by case basis.