This is the first of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies.
I was scanning emails on one of my favorite online discussion lists, the Denver Private Practice Network, [as of 11-04-2011 known as the Denver Therapists’ Network] when I ran across an inquiry from Licensed Professional Counselor, Becky Bringewatt of Mantis Counseling and Coaching Services of Denver, Colorado.
I am applying to [insurance] panels and have not been able to get on because they are full or full for my therapies at this time. I would appreciate any help with this, too.”
I suspect that many of you are struggling to get on insurance panels as a preferred provider. Although I no longer choose to work directly with insurance companies [You can see why here], I know that many of you still choose to do so. In this post, I’m providing the steps you need to go through to apply to become a preferred provider with an insurance company.
Step 1 – Get organized. I can’t stress this enough. Insurance companies are going to want lots of information including . Get organized. If you are going to apply to be on lots of insurance companies, you might as well make lots of copies of your licenses, proof of malpractice insurance, resumes, and other supporting documentation. Just do it now to streamline your process.
Step 2 – Make a list. Insurance companies vary considerably in the amounts they will pay providers. They also vary in how quickly they will reimburse you, how “provider-friendly” they are, and how many hoops you will be required to jump through to obtain reimbursement. That means that it makes sense to be strategic about which insurance companies you choose to be a provider for as well as the order in which you apply. Ask your colleagues who are already preferred providers what their experiences have been with any given company before making that list.
Step 3 – Contact Provider Relations. Call each insurance company that you want to work with and ask to speak with Provider Relations. Every company has someone in this position that can speak frankly with you about their application process. Request an application. They will most likely re-direct you online but this is a good opportunity to start building a human connection. And, while you are at it, ask them what their unique clinical needs are. Every company’s needs are different.
Step 4 – Use your personal contacts. If you’ve already been networking in the field, it’s likely that you have already run across individuals who work in managed care or indirectly with managed care. If you haven’t met those individuals already, now is the time to put that on your networking to-meet list. Employee assistance programs (EAPs) and those employed in provider relations can provide you with shortcuts (like what the needs of that particular company are) and tips (like what most therapists forget to include in the process) for getting your application accepted. Pick their br
Step 5 – Complete the CAQH. The application process can be lengthy and arduous. Plan on 20-30 page applications for most insurance companies and plan on about 50 pages for Medicare applications. The Council for Affordable Quality Health is an online service that allows you to complete one application that over 100 managed care companies use. That can save you a lot of time so consider complete the CAQH to cut down the amount of paper work (potentially 2000+ pages) in the process. (Check out this guest post on how to register with CAQH.)
Step 6 – Copy everything you include in your application. It is not unheard of for applications and supporting documentation to be lost, misplaced, or actually shredded after it leaves your hands and long before the application process is completed. Make sure you copy everything and keep detailed notes about when, how, and who you talk to in Provider Relations and who said what. It is likely that you will need these notes later on so that you sound competent, clear-headed, and informed.
Step 7 – Create and keep paper trails. I’m all about saving trees and minimizing the clutter that can come with paper. However, communicating in writing with managed care can be your saving grace down the road. I recommend that you communicate by phone or face to face to nurture the relationships that you are developing with managed care. However, always follow up important conversations via email so that you will have a paper trail to confirm your understanding of contractual details and expectations. Honor and the spoken word is not enough.
Step 8 – Submit your application and supporting documentation in a timely manner. You will likely be rejected as a provider if you fail to submit a complete application and respond to any additional requests in a timely manner. Those employed in Provider Relations refer to failures of this nature as “timing out.” In order to avoid having your application rejected solely because it has timed out, you will need to stay organized and efficient and respond to their requests for additional information quickly.
Step 9 – Follow up. Once your application and supporting documentation has been submitted, your job is not done. You should again contact Provider Relations and ask them about the timetable for processing your application. I recommend that you contact Provider Relations at least monthly until you have a final disposition of your application.
On Thursday, I will share with you some of the ways to make yourself more desirable to insurance companies in Part 2 of this series, How to Get On Insurance Panels as a Preferred Provider.