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By Healthcare Tech Outlook

For virtually all of the significant health IT vendors, using AI to understand a customer’s behaviors, predict their expectations, and show the correct data at the right time is a top priority.

FREMONT, CA: For several, it is hard to envision the future of Revenue Cycle Management (RCM) in the Artificial Intelligence (AI) era. How does this technology accelerate the business cycle and affect healthcare back-office day-to-day work? It is unknown when AI will be the industry norm at this stage, but there is some speculation about potential advantages that AI can soon bring.

AI Will Simplify Workflows for Medical Billing

Deep learning of the users’ interaction with Electronic Health Record (HER) and billing applications may have the most critical effect on a medical biller’s everyday life. For virtually all of the significant health IT vendors, using AI to understand a customer’s behaviors, predict their expectations, and show the correct data at the right time is a top priority. The ability to retrieve and manipulate information instantly has the power to significantly minimize labor spent on manual billing activities and allow workers to make smarter choices about the next steps to overcome denials.

Enhanced Medical Coding Precision

Its capacity to analyze text and the spoken word would be a core feature of AI. For procedures and diagnosis, systems can learn the language and assign specific codes. After code set updates, this functionality will have a profound effect to ensure the correct codes are used and paperwork is compliant, reducing the change that arises with updates to coding. If AI had been included, think how much simpler the transition from ICD-9 (International Classification of Diseases, Ninth Revision) to ICD-10 (Tenth Revision) would have been.

Immediate Pre-Authorizations

Its capacity to draw assumptions and forecasts will be one of the most critical facets of AI. It can take hours now, or even days, to get a payer’s pre-authorization. Future systems will interpret clinical data from a patient and assess the medical need of treatment within a few seconds. The good news for medical billers is that an automated mechanism will verify that authorization has been received and its related data collected, significantly minimizing (or eliminating) pre-authorization denials due to the absence of an authorization number.

    Clinical Data

Nearly one in five adults in the United States is affected by one or more mental health conditions. Unfortunately, for those living with common mental illnesses such as depression or anxiety, care is rarely coordinated across the entire care team to yield long-term improvement and mental health outcomes.

Join our webinar to explore the unique challenges in managing behavioral health and the benefits that collaborative care can deliver to your customers.

Collaborative Care: The New Model for Solving the Challenges of Fragmented Care in Behavioral Health

Wednesday, February 24, 2021 |12:00 – 12:30 PM EST

Save My Seat

Our host, Colin Banas, MD, MHA, Chief Medical Officer of DrFirst will cover:

• •     The importance of uniting the care and family team (CFT)
• •     The necessity of marrying care collaboration with telehealth in a single, complete, and secure platform
• •     The operational, administrative, and clinical efficiencies that will save your clients time and money

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Colin Banas, MD, MHA,
CMO Medical Officer, DrFirst

Getting on insurance panels requires one very crucial step. We are of course talking about CAQH registration. A provider needs to complete his CAQH profile to even entertain the idea of getting onto an insurance panel.

CAQH aka council of affordable quality healthcare is a program that allows insurance companies to use a single application system for all kinds of credentialing. Today, over 900 clinics, health plans and healthcare organization are estimated to be using it. They require a practitioner to complete their CAQH profile by filling up the CAQH attestation form mandatorily in order to submit their application.

The process although very simple in its premise, can be a little confounding for some to follow. That’s why we have decided to guide you through the entire process to avoid any room for doubts, so you can have a hassle free credentialing experience.

1 – Getting a CAQH Number

Many start their credentialing process before even approaching the CAQH profile. Chances are high that your insurance company is already using CAQH. You can check the list of participating organizations on the CAQH website to confirm this. If a particular company is using CAQH, then they send you a CAQH id number, probably in a letter via mail. You should wait for at least 2 weeks to ensure your application is received by the panel. If you still don’t receive it, then it’s time to give your insurance company a call.

Alternatively, you can choose to register yourself on the CAQH website. As such, you will receive your CAQH number via email. Do not lose this number as you will need it throughout the credentialing process. You need it to fill up your application and re-attest your information.

2 – Have all your information ready

The CAQH process is tedious and time consuming. Nobody expects you to finish it in one sitting as it can literally remove hours from your life. One way to speed up the process however is to make sure you have all the information and material you will need for processing ready.

Here’s a list of all the things you’ll need before you start filling up the CAQH attestation form

• •     Personal information
• •     Education and training information’
• •     Practice location information with certification, address, contact detail, practice type etc. mentioned
• •     Board certification
• •     Disclosure of malpractice history
• •     Malpractice insurance information
• •     Work history

And the materials you’ll need are as follows

• •     Resume
• •     State licenses
• •     Malpractice insurance policy
• •     UPIN, NPI and other ID numbers
• •     DEA certificate (if necessary)
• •     CDS certificate (if necessary)

Make sure all your information is accurate. Your resume should be formatted with the correct date format, which is MM/YYYY, and there should be no gaps in employment. Failure to abide by any of the above requirements can lead to the rejection of your application. So do not rush into your application. Take your time to make sure everything is in order. Remember, errors can cost you way more time and money. Finally, you need to have scanned copies of all the required material in handy as you will be required to upload it.

3 – Start Working on Your Profile

Once you have all the information you need, it’s time to start completing your CAQH profile. We recommend you only undertake this task online. Doing this physically means tackling a dozen pages long application form that only prints correctly in color and cannot be transferred conveniently without a data entry professional to assist you.

Like we said before, you simply cannot complete the profile in one sitting. So take your time, save your progress and continue later. Once you’ve finished the profile click ‘next’. The website will ask you to verify your information once and ask you to attest whether all the information you provided is accurate.

Once you attest, you will receive a message that your profile is complete. Once you’re done, you have a choice to make. You need to make a decision as to who gets to access your profile, whether you will allow any insurance company that exhibits interest in having you on your panel, or choose manually which insurance company gets to see your profile and which company doesn’t.

In our opinion, the first option is the best as it will open you to more possibilities of being invited on multiple insurance panels. Make sure to never lose your application information as you will be required re-attest to the information once in a while, or on a quarterly basis. Respond to the request to re-attestation quickly as not doing so can result in insurance companies refusing to pay your claims.