Insurance Enrollment & Credentialing Services
Insurance enrollment and credentialing services are outsourced activities that help hospitals or clinics to be able to work with insurance companies, often before they open for business. The term “enrollment” refers to the process of applying for an account with a specific insurer. Nomination is the process where you are accepted into the health plans provider network.
Sometimes it is also called “credentialing”. This is notoriously known as one of the most tedious parts of opening a new healthcare facility because it may take months, even years if done by yourself. So outsourcing this task can save you countless hours of work and time spent on something less important than focusing on your core missions.
Our Process
1—Initial Consultation: First, insurance enrollment and credentialing services will look at your business plan to determine the best course of action to take.
2—Proposal: Next, a list of companies you wish to partner with is prepared. This is sent to the appropriate underwriters for “nominations” – i.e., an agreement that they will accept your facility as a network participant or provider – and endorsements – i.e. the inclusion of specific products on your company’s panel of approved services.
3—Acceptance: Once you have been nominated by insurance carriers, the final step is a certification which includes pre-certification approval processes if applicable, service line authorization requests and health plan review procedures, prior authorization requests, and utilization management programs, medical necessity reviews, and claim edits/postings.
4—Credentialing: Insurance enrollment is the first part of credentialing. A final step that completes insurance enrollment is to submit data on all providers within your network to the health plan for inclusion in their directories. They will then send you a list of all healthcare providers affiliated with your facility which are now included in the insurer’s provider directories, ensuring smooth reimbursement for patients who are seen by these clinicians throughout the whole city or state.
5—Ongoing Support: The final step is ongoing support – your account manager stays involved with insurance plans and works closely with them on any updates that may be required as regulations change and demands shift over time.
Getting In-Network Insurance Groups & Plans
Health care today is a highly competitive industry. The ability to accept insurance plans and billing as an in-network provider can make or break your practice’s success! That’s why it’s so important that prospective patients have easy access to their preferred medical professionals through easily accessible online databases like medicare advantage directories which list out all covered professionals by city nearest you.
The insurance company will verify that you meet their internal requirements so that they can serve as an in-network provider to the panel and database. This could include your state, complexities of permits, etc., level education training experience – all this is verified before being allowed access into any panels/databases!
Insurance Companies Offers
Once your practice or organization has been accredited by the insurer, you can send invoices straight to payers. In addition, many insurance companies offer providers other incentives, such as:
- Referrals.
- Preferential.
- Reimbursement rates.
You can include your affiliate links in many different places, including the web-based directories of major networks. This will help you reach more potential customers who are looking for a specific service and want an honest opinion from someone they trust!
We know how to get your application approved! Just contact HealthQuest and we’ll make it happen for Medicare, Medicaid, Tricare, BCBS, Top-10 Commercials Including Aetna, Cigna, Humana, United Healthcare, WellCare, and more also a few such as Workers Comp, Out of Network Multiplan, Uninsured HRSA Programs, etc.
Credentialing Process...
- Network Research
- Payer & Clearing house requirements.
- Application Filling and Follow-up.
- Re-credentials and timely follow-up.
- Approaches and Appeals for closed Networks.
- Out of Network Enrollments.
- Fee Schedule Negotiations.
- Demographic Changes.
- CLIA Updates.
- EDI & ERA Enrollment.
- Annual Credentialing Maintenance.
- PECOS AND CAQH Setups.
- Insurance Portal Setups.
- Backdated Enrollment.
- W9 Setup.
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When I look at Healthquest I look at them as Operators, we don’t look at them as consultants. There was always a conversation about why did we outsource. Unfortunately, we have to change several software and applications in past but selecting the right revenue cycle partner is like security assured income.”
“We are glad to meet partners, not a third-party vendor who knows out-of-network billing with top insurances. Healthquest creates a better environment for the sales reps and we will be able to grow our volume and revenue and achieve a better outcome.”
We never had an idea to validate genetic services in our chain of labs special thanks for HealthquestRCM Validation-Molecular and Revenue Cycle team we are delighted with your services and knowledge