Lately, I have been receiving a lot of phone calls from doctors offices requesting that we (Capital Billing Services, Inc) assist them with credentialing and contract negotiations with insurance carriers. It was largely expected that with all the technological advancements, and strides that the Insurance industry has made, the process would have become simpler and less complicated.
The truth is, with resources like CAQH, online credentialing and paperless information delivery, the process has become very efficient, fast and at the same time very complex. Providers have to enter all the pertinent credentialing information into CAQH, a process that takes an experienced person about 2 - 3 hours to complete. It is important to note that not all insurance carriers participate in CAQH. CMS (Medicare) still requires all the paperwork to be mailed in with every application. Most Worker's Compensation plans do not participate in CAQH either and therefore the paperwork also has to be mailed with the application.
With a lot of practices switching to EHR/ EMR programs, the need to also go paperless on claims submission, remittance advice delivery and patient statement billing has arisen. Most of the carriers require separate applications to be sent to the carriers separate from the credentialing process. In today's market, the need for professionals with extensive knowledge on all the above and other insurance requirements continues to grow. We will utilize this blog to keep posting ideas and relevant topics to in order for other like minded professionals to share ideas and suggestions on how to continue navigating through this muddy insurance waters. I hope you will all find the blogs helpful.
