Should new clinicians panel individually or under our group? Should I set up a group contract with the insurance company?
Group contracting is best, when available to you and your group. There are specific criteria and requirements with many insurance carriers. Processing claims, negotiating reimbursement rates, and general credentialing/re-credentialing are easier and faster to process due to being under the same tax identification number.
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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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Something that we are frequently asked is how we organize our credentialing. With so many documents required and providers to keep track of it can be easy to feel overwhelmed. So we asked our credentialing team.
How to organize and streamline the process:
Most individual providers and groups are not able to afford special credentialing software for their practice. One tool I’ve found useful and CHEAP in helping to organize the whole process is just a basic Microsoft Excel spreadsheet. Formatting it to list the insurance companies you are working with helps you to stay on top of credentialing and re-credentialing, including hospital privileges. Use the spreadsheet to notate what date you submitted the application and by what means (fax, email, or online website). You can also keep notes on your follow-up noting whom you spoke with at the insurance company and approximate how much longer until the provider is in-network. Microsoft Excel tools are also able to highlight columns or specific blocks to jump out at you as you are going through your week. You can highlight one color to term providers, one color to follow-up with insurance companies, etc. It’s a great way help you plan your schedule at a glance.
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What do I do once my clinicians have completed their application to participate?
Follow-up with the insurance companies to confirm receipt and check the provider status. Typically it takes 90-180 days for applications to be processed. Some insurance companies are able to confirm receipt of application within 2 weeks, other companies are not able to confirm receipt of application until after 90 days due to the different departments the application goes through. It is best to check at least every 30 days if not more often.
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Information you should gather before you start credentialing:
Start as soon as possible. The credentialing process can be lengthy depending on when you hit the insurance carriers credentialing cycles and they are all different. Typically applications are processed within 90-120 days, however, I have experienced a carrier that has taken a 1 ½ years to become impaneled with due to their credentialing cycles. It was very frustrating to say the least.
Details Matter. Most clinicians don’t like to do their own credentialing because it can be very tedious with all the details. When completing applications details matter, just like in 1st grade, follow the directions. The boxes and checklists are on the application for a reason. Complete every section and make sure you enter the correct information, for example: know which NPI is being asked for, is it the individual NPI or the group NPI number. Leaving a box incomplete or left blank can hold up your application or cause it to be rejected. Due to the insurance companies merging over the past couple years, the provider reps don’t always have time to call you for clarification on whether your service location is ADA compliant or double checking dates on your employment.
CAQH is up-to-date. Many times the CAQH (Council for Affordable Quality Healthcare) is the first stop for insurance companies when processing your application. It must be current and accurate, otherwise they have to track you down for the correct information, which is of course causing a delay in your application, thereby delaying your acceptance to panel and delaying when you can see clients and get paid in-network reimbursement. Staying current also tends to make re-credentialing a breeze