How To Apply For Insurance Panels? Comprehensive Guide

You have found the proper place if you are looking for information on applying for insurance panels. This article will look at how various insurance providers earn their qualifications. An insurance group is a collection of doctors and therapists who have joined forces to provide care to policyholders.

In order to obtain insurance coverage, one must first go through the credentialing procedure. It is at the discretion of the insurance company to accept you onto its panel.

You will be asked to provide appropriate identification before membership is granted. Every insurance firm has its own team of experts. As a result, if you plan to negotiate with multiple insurers, you’ll need to provide each with its own certificate.

What are Insurance Panels?

Interested in joining insurance panels but don’t know where to begin? You have found the correct resource. This article will guide you through the process of obtaining insurance company credentials.

A group of therapists or physicians who have agreed to cooperate with an insurance company to treat their policyholders.

Acquiring insurance panel participation is referred to as “credentialing.” The insurance company will decide at this time if you will be allowed to join their network of preferred doctors. To be invited to join, you must first demonstrate your eligibility.

The insurance companies all run their own separate panels. In order to be accepted by more than one insurance provider, you will need to undergo the credentialing process for each organization individually.

Advantages Of Applying For Insurance Panels

The insurance provider is acting as your referee. The integrated reference is the most compelling argument in favor of obtaining insurance company certification. You won’t have to sell your practice because of the short time frame.

There is at least one reliable reference source you can count on. The insurance company is, in effect, promoting you. In other words, they have highlighted you as a go-to vendor on their site. Search engines are frequently used by insured clients to locate insurance. Other benefits are listed here. In addition to instructions on how to join an insurance panel, below are some benefits of doing so:

#1. Need for insurance

The average American makes too little to pay for private mental health care. A sizable portion of the population continues to view access to mental health care as a “luxury.” In order to reduce out-of-pocket costs, some individuals choose for insurance policies. Customers without health insurance may be a problem you encounter. To understand insurance, you must first understand its fundamental function.

#2. Limited database

Focus on a subset of your clientele instead than trying to please everyone. When dealing with mental health issues, anonymity may be a priority for some patients. They do not want information on the mental health of a third-party payer to be made public. It may be preferable to operate as a self-paid practice outside of panels if the majority of your clientele is concerned about maintaining their anonymity.

#3. Legitimacy

A higher level of trust may be accorded you if you have the proper credentials. In order to avoid the lengthy registration process required by the insurance sector, some patients seeking therapy immediately seek out therapists who have completed it. That the therapist goes the extra mile is, in the eyes of some, evidence of their competence. If you are just starting out as a therapist and are in the midst of building a clientele, it may be worthwhile to learn more about the credentials process.

Drawbacks Of Insurance Panels

Many positive aspects can be attributed to the insurance panel. However, you should think about the drawbacks before applying. So, let’s break it down and talk about each one individually.

#1. Waiting time

If you let clients pay independently, you’ll get paid right away in cash, by credit card, through PayPal, or some other legal means of payment. As a result, you won’t have to wait months to get paid. If you go through a third-party payer, however, you not only have to wait for payment, but you also have to dodge various obstacles (paperwork).

#2. Inability to gain independence

A certificate issued by an insurance firm carries with it certain obligations. Don’t go trying to set your own prices. The insurance company has complete discretion over the rates of compensation, and you must adhere to them. This also means that you will likely make less money from each individual customer than you would if you set your own prices.

Which Insurance Panels Should I Join?

When looking for an insurance panel, there is no one clear choice. Your unique circumstances and geographic location will determine which insurance panel is best for you.

However, most service providers should begin their search with the larger insurance panels. Customers for these major insurance firms can be found in every state. It is in a doctor’s best interest to see as many people as possible. Access to a sizable insurance panel is a critical factor in the overall success of a medical business.

Consider joining the panels of some of the top insurance firms in the country, including:

• Blue Shield Blue Cross
• Aetna
• Cigna
• Humana
• Considerable Choices
• TRICARE
• Medicare
• UnitedHealthcare
• Anthem
• Centene
• Emblem Health Icon
• Foundation Kaiser

Due Diligence

Be mindful that there is no cookie-cutter method for becoming an insurance panelist. When considering a partnership with an insurance firm, it is important to conduct thorough research. Selecting an insurance panel to join just on the basis of its size alone is not a sufficient rationale.

Instead, find out what people in your area really want and need.

Working in North Carolina, for instance, you should be aware that a sizable portion of the population is made up of active duty and veteran service members. Therefore, TRICARE is an alternative worth considering. The Blue Cross Although Blue Shield is a well-known insurance provider, Connecticut residents should know that Emblem Health is the dominant player in the state when it comes to health insurance. 1

The Value of Smaller Insurance Panels

It makes sense to join the provider network of a major insurance provider in your area. But if you don’t sign up for smaller insurance panels, you could be leaving money on the table.

For the sake of argument, let’s pretend that Company A insures 150 people in your area, whereas Company B serves 65, Company C serves 55, and Company D serves 40. At first look, it could seem like the best option is to partner with Company A. However, when Companies B, C, and D are added together, they have 160 patients in their network.

Therefore, it may be preferable to join the other panels if the credentialing process for Company A is highly time-consuming and challenging, or if the reimbursement rates for Company A are not so excellent.

What’s the Process of Getting on an Insurance Panel?

Formalities and time are needed to join an insurance panel.

Every application you submit will require you to fill out a large number of pages. The next step is to wait after submitting the application. You’ll apply again, and then wait some more. Finally, if everything goes well, you’ll find out if you made it onto the panel.

What is CAQH?

The abbreviation for the Council on Affordable Quality Healthcare is CAQH. Insurance firms came together to join this non-profit consortium in order to standardize the credentialing application process. CAQH is used by over 100 managed care organizations for application processing. The majority of big insurance firms use a CAQH to validate the information you report to them.

That’s great news because it means you’ll only have to submit your CAQH application once, even if you’re applying to multiple panels. Authorizations can be given to any insurance provider you choose throughout the CAQH setup process.

The application process for CAQH can be time-consuming and involved. You can expect to fill out anywhere from 20-50 pages (50 pages for Medicare).

You can submit your application on paper if you like, however we recommend applying online. Online submissions are quicker and more secure (no paperwork to misplace), hence they are preferred.

Keep multiple copies of any important paperwork. Take down the names of the people you spoke with and the dates you sent in your papers.

Steps To Apply For Insurance Panels

It may be difficult to get on insurance company panels. It’s not surprising that many therapists have to rely on direct pay clients because of a lack of success with referrals and long waiting lists. Even without these setbacks, the paneling process could take as long as four months. Here are the actions you need to do to apply for the insurance panels:

Step #1: Prepare the documents needed

Extensive information and paperwork, such as proof of liability insurance for your owner, advanced training, or documentation qualifications, are necessary for paneling. Moreover, the location of the practice, the National Provider Identifier (NPI), and evidence of insurance coverage are also necessary for the licensing process.

Step #2: Complete the application

The paper application is rather lengthy, only available in color printouts, and can only be filled out by administrative staff (if they ever get around to doing so). You will be required to “retest” your application multiple times per year, thus it is imperative that you save a backup copy of all of your submitted data just in case.

Get back to people who have questions like that as soon as feasible. If you don’t, insurance companies may deny your claims.

Step #3. Contacting the provider

The next thing to do is choose the insurance boards that interest you. Their reimbursement rates, provider-friendliness, payment timelines, and restrictions may vary widely. Furthermore, several industries require substantial post-licensing experience gained over time.

It is important to utilize your network by soliciting input and guidance. When you are ready to apply, please contact your preferred insurance company’s Provider Relations department.

Between filling out the application, making any necessary follow-up calls, and finalizing the contract, the entire application process can take up to 10 hours per panel. As a result, you should follow up on your application periodically. If your application has been pending for a long time, it may time out and you will have to start over. Make sure the insurance company receives all necessary paperwork by calling them. Since transmissions can easily corrupted, destroyed, or deleted, it is important to always keep a backup copy.

Following Up is Important

Your application should not be lost in the void. Contact the insurance provider’s customer service to inquire about the status of your application.

Keep in mind that it is you who is seeking inclusion in the insurance company’s database; the company’s representatives are merely responding to your request for information. It is your obligation to verify that they have received your application and are working on it. Your application may time out if it is not processed in a timely manner, forcing you to start the application process over from the beginning.

Call every few weeks after submitting the application to see whether you were accepted (or rejected). Be aware that before contacting some businesses, a 45-day waiting period is mandated.

Between two and four months may pass when the process is completed. It may take up to six months or more if you have to file an appeal. So, it’s best to prepare ahead of time if you want to begin a private practice that requires credentials.

Should You Hire a Credentialing Company?

Hiring someone else to handle the paperwork and follow up can be helpful, but it won’t come cheap. You’ll have to weigh the benefits of spending a few hundred dollars per certification vs the time saved by not having to fill out the appropriate paperwork yourself.

Asking for guidance from an experienced therapist is another viable approach. Inquire with a member of the reviewing committee. They may be able to provide you some useful advice.

It’s A Wrap!

You’ve finally sorted out the insurance panel application process. But before you sign the dotted line, make sure you thoroughly understand the contract’s document, claim, and appeal processes. Check out our post on beauty parlor insurance to learn more about this topic.