Medical Credentialing, sometimes referred to as “insurance credentialing” or “provider enrollment”,  is the process of becoming affiliated with an insurance company so that you can accept…

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…third party reimbursement from your patient’s insurance plans.

Why is it important for the success of your practice to become credentialed with insurers?

More people in the United States have health insurance than ever before and patient’s  demand that their healthcare providers accept their insurance.   If you’re not in network with a potential patient’s health insurance plan, you’re at risk of losing that potential patient to a competing practice.

What insurers should I get credentialed with?

If you are completely new to private practice, there are major insurance companies that we recommend you be credentialed with: Aetna, Blue Cross Blue Shield, Cigna, Humana and United Behavioral Health as these are some of the largest insurance companies in the industry.   Beyond that it is also important to look at those insurers in your geographical area supporting your specialty. That’s where Denmaar can help as we have clients spanning from the east to west coast and can provide you with a recommendation on other insurers your practice should be paneled with. 

While important for the success of a clinical practice, “getting credentialed” on insurance panels is often an unwelcome distraction from providing quality care to patients.    Enrollment applications  are time consuming to fill out and require allot of followup to ensure you are enrolled as quickly and efficiently as possibly.  Denmaar’s  medical credentialing service exists to take the hassle out of getting “in network” with insurance panels. 

Denmaar’s credentialing services include: reviewing your current insurance portfolio: checking your panel status, recommending additional insurers for your specialty and geographic area, complete and submit enrollment applications and manage the entire credentialing process – which can take anywhere from 30-120 days.

What  is CAQH and why is it important?
CAQH, the Council for Affordable Quality Healthcare, is a credentialing tool that houses self-reported provider data. 

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CAQH is used by most insurance companies as part of the application process to complete one’s medical credentialing (i.e., to get on insurance panels).  Most major insurance companies, like Aetna, BCBS, Cigna, Humana, Magellan and United Behavioral Health use CAQH as a part of their application process.

Why choose a behavioral health billing company to do your CAQH profile? Because Denmaar not only does billing, we do credentialing too.  We are familiar with exactly ​what ​ behavioral health insurers are looking for to ensure you go through the credentialing process as quickly and painlessly as  possible.  

Most providers don’t know what different insurance panels are looking for until they have already begun the credentialing process and then it’s too late.  Numerous letters have to be sent to the providers requesting additional information or corrections be made or up to date documents need to uploaded all delaying credentialing applications that already takes between 30-120 days.

With our experience we have found that insuring your CAQH profile includes all the required info, is up-to-date and recently attested to is the key to getting on insurance panels fast.

If  you do not have a CAQH profile, we will create your CAQH profile.  If you already have a CAQH profile, we will review your  profile to ensure all the necessary information is up-to-date so there is no delay in getting your credentialing application approved.

Denmaar’s credentialing expert will also  process and track your credentialing application handling all requests for additional information or clarifications through par approval.

Please call or email us for additional information or to learn more about any of our services!