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What are the top insurance companies to be credentialed with?

It wasn’t long ago when practitioners considered credentialing to optional. You could start your own practice and derive profits from it without ever caring for credentialing. Plus, insurance companies weren’t even allowing certain medical practices like mental health clinics a place on their panels.

Fast forward to modern time, and things are not what they were just a couple of years ago. Credentialing has become crucial for medical practices to survive in an increasingly volatile and competitive industry.

Most American citizens today are covered by an insurance plan provided by some company or the other. If a budding practitioner fails to get credentialed with the insurance companies, then he will lose clients to his competitors.

Hence, having the knowledge of the top insurance credentialing companies is essential in a practitioner being able to thrive in the industry.

So let’s look at some of the top insurance companies to be credentialed within the USA.

So, there are a few ways to determine which top insurance companies in the USA are the biggest in terms of a client base. Their popularity can be due to the following factors:

• Companies Goodwill
• Lives Covered
• Company revenue
• Accessibility etc.

Based on the above factors, we were able to list down the following behemoths. If you are a provider looking to get credentialed, you might want to get in touch with them.

1) United Health Group

Our first name on the list is ranked 3rd on the 2019 fortune 500 lists. United Health Group is a for-profit healthcare company based in Minnesota. As of 2019, it is one of the largest healthcare insurance companies in the world with total revenue of $226 billion, along with 115 million customers. It is divided into four divisions that together provide health benefit plans and services for large national employers, to individuals age 50 and older, to serve state programs that care for the economically disadvantaged, and medically underserved.

2) Anthem 

Anthem INC is also one of the largest providers of health insurance in the United States. As of 2019, the company has over 40 million customers under its belt. It is one of the largest for-profit healthcare companies in the Blue Cross Blue Shield Association. Today it operates as Empire blue cross blue shield in the state of New York and as Anthem Blue Cross Blue Shield in 10 other states.

3) Aetna

Aetna is recognized as one of the leading providers of health insurance in the United States. Aetna continues to grow stronger, with millions of users enjoying its medical plan. Hence many physicians and medical practitioners want to become participants in the Aetna healthcare network. The company’s extensive network includes over 22.1 million medical members, 12.7 million dental members, 13.1 million pharmacy benefits management members, 690,000 primary care doctors, 1,200,000 healthcare professionals, and 5700 hospitals. 

4) Humana

Humana Inc is a health insurance company based in Kentucky, Louisiana. Over the years, it is responsible for amassing over 13 million Americans into its healthcare program. With revenue of $41.3 billion, Humana was ranked 56 on the Fortune 500 list.

Now, Humana credentials and re-credentials all licensed independent practitioners including physicians, facilities and non-physicians who fall within its scope and authority.

5) Cigna

 Cigna is a popular American health service organization based in suburban Bloomfield, Connecticut, and Philadelphia, Pennsylvania. Their insurance subsidiaries are major providers of mental, dental, accident, and life insurance to American citizens.

Cigna is known to provide Medicare and Medicaid programs to an individual in the US and some international markets. Hence many physicians and medical practitioners want to become participants in the Cigna healthcare network. To become a participant, however, healthcare services need to apply for Cigna Insurance Provider Credentialing.

According to Market Share, US News and World Report rated the following top insurance companies to be the most popular in the US.

• United Health
• Kaiser Foundation
• WellPoint INC.
• Aetna 
• Human
• Independent Blue Cross Group
• Highmark
• Cigna
• Blue Shield of California

How Denmaar Can Help you Get On these Panels

Getting on insurance panels has never been as crucial as it has been today. With many American citizens now covered under an insurance program, it would be foolish not to get credentialed with an insurance company. However, credentialing has also become a challenge because most panels are almost full and are not taking in new providers.

Denmaar knows the credentialing world from top to bottom. We have assisted many practitioners, both group and private through the entire credentialing process and continue to do so till date. We are the insurance credentialing experts you need to crack the overwhelming process of credentialing for the best of your merits. At Denmaar we do the heavy lifting, so you can concentrate on tending to your clients.

When it comes to insurance credentialing and Contracting, you have to understand that they are two sides of the same coin. Both need to seamlessly go hand in hand for an individual or group practice to get on insurance panels.

In this article, we’ll try to simplify the concepts of both Insurance Contracting and credentialing and find out how the two concepts intertwine with each other.

Insurance Credentialing

Credentialing is a process providers need to mandatorily undertake if they seek to serve clients covered by the federal insurance program. The applying provider needs first to verify his/her professional records to get credentialed.

This includes NPI, CAQH, professional licenses, diplomas, certifications, attestations, references, etc. All of these documents are essential to verify the accuracy and reputation of the concerned provider.

The same process applies if the Individual provider is applying for privileges in a group practice such as hospitals and surgery centers. They will be asked to submit a completed application which would be later sent to the credentialing entities for verification.

They will request the provider’s professional documents which may include National Data Bank records, credit card records, and criminal background searches.

They will also indulge in what is called primary source verification, which basically means verifying the source of the provider’s diplomas and educational certificates. There is no way to avoid this as hospitals are mandatorily required to check the above-mentioned documents to protect their patients from bad actors.

The Entire Credentialing process can be summed up as follows:

• Getting Information in Order
• Filling out the CAQH form
• Contacting Provider Relations
• Submit Application
• Reviewing Contract after Approval

As you can see, Insurance credentialing is a lengthy process. It is advised to seek help from third-party service providers like Denmaar to efficiently carry out the overwhelming process. The entire Insurance Credentialing and Contracting process culminates with the approval of the contract by the insurance company.

Contracting

If credentialing was the process of gathering and submitting information, contracting is the process of submitting the information and obtaining credentialing approval. This is where the provider finally obtains participation on an insurance panel. This means he/she can now take in clients that are covered by the health insurance coverage of that particular company. We often see providers enroll in these plans, only never to renew them again.

It is almost as if they forget that their application with a said insurance panel comes with an expiration date. A lot of time may pass by, and insurers may not review your contract, thus failing to reflect on the provider’s reimbursement rates. This spells a recipe for disaster as it can lead to thousands of dollars lost and payments interrupted.

Denmaar’s Insurance Credentialing and Contracting for Providers

Although time-consuming, there is a reason why credentialing requires such a high level of scrutiny. The affordable care act has raised the standards of such scrutiny to reduce fraud and abuse when it comes to Medicare and Medicaid enrollment.

The same applies to the contract. It is essential to be aware of the information contained in the contract of approval. Attention needs to be paid on when the period of credentialing may expire, to apply for re-credentialing quickly.

Denmaar is a mhBilling company that helps providers with both credentialing and re-credentialing. We offer a fully automated system to our clients that keep them updated in real-time with updates regarding their application. At Denmaar we are not just concerned with verifying your forms. We also ensure you are always in touch with your process to ensure your credentialing process is as smooth as possible.

Let’s understand the process of Oscar Insurance Credentialing

Oscar insurance company is a technology-focused healthcare company that was founded in 2012.
Headquartered in New York City, Oscar provides its services in 9 states across the USA. These 9 states include New York, New Jersey, Ohio, Texas, California, Tennessee, Arizona, Michigan, and Florida.

The company has been popular for using advanced technology to engage with their clients. They use telemedicine; healthcare based technological interfaces, and transparent claims pricing systems.

Oscar began selling insurance the same year the affordable care act exchanges and individual mandates went into effect. In the first year, Oscar managed to secure 16000 members, and it has progressed into even more significant numbers ever since.

As of today, there are at least 25000 members covered under Oscar’s insurance program. They have not only partnered with 3500 nationally ranked doctors, but also work with 20 top health systems in the US.

Hence credentialing with Oscar is crucial if your practice falls under their jurisdiction. This will allow you to tap into a client base that is covered under the Oscar insurance program. So without much further ado, let’s look at the process Oscar Insurance Credentialing for providers.

Oscar Insurance Corporation Provider Credentialing – The Process

1. Pre Application

Before applying, Oscar requires practitioners to submit the necessary information to confirm that the applying practitioner is meeting basic guidelines of insurance credentialing with OSCAR. An Oscar representative is assigned to the practitioner who informs whether the applying party meets all the mandatory guidelines or not.

2. Submit Your Application

Once the practitioner is deemed compliant with Oscar’s guidelines, they send an e-mail containing all the information the provider needs to initiate the process.

If the application information already exists on the CAQH aka Council for Affordable Quality Healthcare, then OSCAR will with the provider’s permission, proceed to access it electronically.

The following information is essential from the provider, depending on :

•   Basic Personal Information
•   Education and Training Information
•   Specialties and Board Certification
•   Malpractice Insurance Information
•   Work History and References
•   Disclosure and Malpractice History

Here are some materials you’ll need:

•  CV or Resume
•  Malpractice or Insurance Policies
•  Drug Enforcement Administration Certificate
•  State Licenses
•  W9’S
•  Various applicable ID numbers

3. Follow Up

Once Oscar Insurance Credentialing receives the application packet, they will start the credentialing process. The entire process will take 45 to 60 days to culminate.

During this time, the provider will receive e-mails regarding:

• Confirmation of Application received
• Request any missing documentation or application information. If any fundamental document or information is found to be absent during the process, Oscar will send a notification, notifying about the closure of that particular application.
• Constant updates about the status of an application, including delays if any.

4. Oscar Approval

If Oscar approves a particular practitioner’s application, the practitioner becomes an in-network provider with OSCAR. Oscar health Insurance Credentialing will updates the provider information in their database within the next 10 business days.

Being an Oscar in-network provider can be a very long and tedious process. The entire process requires at least 90 – 120 days to be completed and approved. There is a lot of paperwork, which makes the whole process quite frustrating for medical practitioners who want to accept clients with medical insurance. That is where the professional assistance of Denmaar comes into play.

With the help of our credentialing experts, we can walk you through the entire process by accomplishing tasks without any complications and hassle so that you can work on other core areas of your medical practice.