With the introduction of the reimbursement process measure through the quality of service, MIPS or MACRA, the payor credentialing has become important for the care providers of every healthcare sector. The insurance companies reimburse those healthcare entities or professionals that are enrolled and credentialed with the Council for Affordable Quality Healthcare (CAQH®)

Provide Credentialing and Re-credentialing

Credentialing is the process of registration of the healthcare provider with insurance company. Re-credentialing process is repeated reinsurance of the credentialing process. Usually the insurance companies or credentialing network send a notification for re-credentialing after 3 years of your registration with the specific institutes.

The credentialing process is the same for the healthcare providers working across different healthcare fields but for the behavioral healthcare professionals registration with Tuft Health plan is necessary. Common steps of the credentialing process for behavioral health professionals are

Finish credentialing application of (CAQH®)

To join the list of credentialed healthcare providers like Tufts Health plan providers and others require credentialing with CAQH. Most insurance companies accept CAQH credentialing. Complete your application with accurate and complete data. In the case of an already registered member, you can recheck it requires re-credentialing.

Ancillary Practitioner Data Form

After completing the CAQH application form, you must fill out the Ancillary Practitioner data form. Completing the Ancillary Practitioner data form is necessary for the Tufts Health plan. There is a separate Ancillary Practitioner data form for behavioral health clinicians, clinics, and BCBA.

Complete Documentation

The third step of credentialing process is to complete the required credentialing documentation. A list of documentation is mentioned below.

• Form W-9
• A photocopy of General Liability insurance covers the physical work facility, including dates, location, and the amount covered in the insurance.
• The credentialing application checklist provides the document checklist. Additional documentation is required for behavioral health clinics, as mentioned in the checklist.

A professional credentialing services provider can aid you in the documentation mentioned above. They can notify you of any mistake during the compilation of documentation.

Submit forms and documents to the insurance company

Step four of credentialing process is application submission to the insurance providers. You must scan and submit all the documents electronically. Try to be sure that every document is attached to your email. A single error or omission of a required document may lead to denial of the credentialing application.

Review

Tufts Health Plan’s Allied Health Department only processes the applications that are complete. The department will notify you in case of discrepancies like wrong or missing information. You must audit your application thoroughly before submitting it to Tuft or CAQH. It is important to follow up on your application through email or phone. A provider credentialing expert will take complete responsibility for the Paperwork and follow up until the credentialing process is complete. Technology is also helpful in better decision making.

After approval process

After the approval of your application, the credentialing department (Allied Health Contracting Department) will send you two hard copies of the approved credentialing application for signature. You have to sign both of the contract copies and resend them to the department.

Contract Signed

Credentialing is a contract between Tufts Health Plan and the healthcare provider. Tufts Health Plan’s contract manager will counter sign your credentialing papers. The department will send you an original signed copy of the contract with a “welcome packet.” The welcome packet includes your credentialing data, claim submission information, and other resources for the providers working with Tuft Health Plan members.

Your name appears in the list of the credentialed care providers with the specific department.

End Notes:

The process of payor credentialing is not only time-consuming but requires tons of Paperwork. Secondly, in case of a single mistake in the payor credentialing process will require resubmission. Sometimes the Paperwork involved in the process and follow-up with the insurance company become a headache for the healthcare provider.

You will require to go through the  credentialing process, when you switch the organization or the geographic location of your services. Re-credentialing process also requires the same time and procedure like the first time of credentialing process.

Because a healthcare provider is not a specialized credentialing professional, you can outsource a professional credentialing services company to avoid time wastage and hassle. Usually a medical billing company can also providers payor credentialing services as well.