Contracting (going in-network) with insurance companies is a complex process that requires a significant amount of time and effort. In order to successfully contract with insurance companies, medical practices must understand the process and take the necessary steps to ensure that they are able to secure in-network contracts.
The first step in the process is to research the insurance companies that operate in your practice's area. This includes identifying the insurance companies that are most active in the area, as well as those that have the most members. This information can be obtained from the National Association of Insurance Commissioners (NAIC) or from the state insurance department.
Once your medical practice has identified the insurance companies that you would like to contract with, the next step is to gather the necessary information and documentation. This includes the practice's National Provider Identifier (NPI) number, tax ID number, and insurance license number. The practice should also have a list of the providers that are employed by the practice, including their credentials and specialties.
The next step is to complete and submit the necessary paperwork to the insurance companies. This typically includes a provider application, a provider agreement, and a credentialing application. The provider application and agreement are used to provide the insurance company with information about the practice and its providers, including their credentials and specialties. The credentialing application is used to verify the providers' credentials and qualifications.
Once the paperwork is submitted, the insurance companies will begin the process of reviewing the application and conducting background checks on the providers. This process can take several weeks or even months. The insurance company will also conduct site visits to the practice to ensure that it meets their requirements. If any issues are identified during the review process, the practice will need to address them before the insurance company will approve the contract. This process often requires following up with the insurance company numerous times to make sure the insurance company completes the process.
Once the insurance company has reviewed the application and completed the site visit, they will make a decision on whether to contract with the practice. If the contract is approved, the practice will need to negotiate the terms of the contract, including the reimbursement rates and the services that will be covered.
Once the contract is signed, the practice will need to maintain compliance with the contract terms and the insurance company's regulations. This includes submitting claims and other required paperwork in a timely and accurate manner, as well as ensuring that the providers adhere to the insurance company's guidelines for providing care.
In summary, contracting with insurance companies is a multi-step process that requires a significant amount of time and effort. Medical practices must research the insurance companies that operate in the area, gather the necessary information and documentation, complete and submit the necessary paperwork, and negotiate the terms of the contract. Additionally, they must maintain compliance with the contract terms and the insurance company's regulations. It's a challenging process but is a critical aspect of running a medical practice.
In our experience, it often requires 9-12 months to contract with most insurance companies. We have experts that can help with the entire contracting process. Contact us for more information.