Tips On Becoming A Preferred Provider
You have organized all your important documents, pulled together your logins and passwords for your CAQH and NPI accounts and are getting ready to submit all your applications. While attending a CEU training you hear from a colleague at a CEU training one of the insurance companies you planned to join is no longer accepting new clinicians.
How can you set your application apart from all the other contenders in the area?
Tip #1: Credentials Matter.
Insurance companies prefer clinicians with training. A provider that is certified in EMDR or DBT for example, registered as a play therapist or has a Chemical Dependency license may have a better chance of reaching the top of the pile.
Tip #2: Less is More.
When listing your specialties and treatment modalities, don’t list all of them. Stick to the more desirable and unusual. A clinician that speaks English and Spanish and treats depression is more likely to gain a slot in the “closed or limited” network than a clinician that speaks only English and treats depression.
Tip #3: Think real estate. Location, location, location!
Yes, location matters. If you receive a rejection letter after applying to an insurance company due to the area “being saturated” or “no need for your specialty” that is what they are saying. Seek an area that is under-served.
Tip #4: Check your work schedule.
Who wants to see a therapist at 7pm? A working mom of a teenager that has soccer practice right after school and games on Saturday. Think of the age and demographics of your clients. Are they school age children, retirees, or working adults? Offering hours in the evening and on weekends is more desirable for many clients and the insurance companies are aware of this.
Tip #5: The squeaky wheel gets the oil.
Yes, you need to be the squeaky wheel. After you submit your application, you need to continually follow-up with the insurance companies. First call to provider relations is to confirm receipt of the application, then a couple weeks later to check the status, and yet a couple more weeks later to check the status again. You get the idea. The more you contact them (every two weeks or so) the greater chance of your application being accelerated.
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1. Every paper in a chart (including the intake paperwork, DSM scales you used for assessment, drawings done by client, journal entries they bring in, worksheets, etc) needs the clients name and date at the top, as well as your signature and date at the bottom.
2. All aspects of the detailed progress note need completed in order to be compliant with insurance requirements for all in person points of contact.
3. Document all phone calls, print all e-mails and do a note for all late-cancels/no-shows (document how you contacted them or they contacted you, whether they were charged and why, and follow up plan). These notes should NOT indicate in\out time, modality, persons present, etc
4. Notes need completed and filed before you leave on dates of service. Tragedy can strike you or client at any time.
5. Time in and out must match modality you are billing, name must match the legal name being used by insurance or on client’s ID and that name must be on all forms. If there is a different preferred name, you can indicate that in quotes. Ie: Melinda “Mark” Smith, or Aaron “Joe” Smith. If a couple/family is being seen, all documentation needs to be under the identified/billed clients name and from their perspective….all references to other people are “client’s husband states… or Mark states” etc. Also get multi person release signed.
I have been audited before (not fun) and have recently discussed documentation standards with board. They are clear on the above-mentioned issues and insurance companies can take back money for any of the above issues as well.
Tip from a real clinician -
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