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Insurance credentialing for nurse practitioners is as vital as for other practitioners in the field. However, the dynamics of credentialing is quite different for nurse practitioners than others. Its challenges are different and can cause a lot of distress for the uninformed.

In this article, we will look at some of the challenges faced by nurse practitioners that are exclusive to their faction. It is essential to know the hurdles you face, so when the time comes, you can jump over them with ease.

Challenges with Insurance Credentialing For Nurse Practitioners

Restrictions with License

Nurse practitioners throughout America have to go through various forms of restrictions when it comes to licensure. It varies from state to state. Some states allow Full Practice license to nurse practitioners. This means that they are allowed to evaluate, diagnose, interpret diagnostic tests, initiate or manage treatments and prescribe medications in accordance with the exclusive licensure authority.

Read More: Importance of Nurse Practioner Credentialing for Nurses and Healthcare Organizations

In reduced practice states nurse practitioners require a regulated collaborative agreement with a physician. The collaborative agreement is mandatory if NP’s wish to offer patient care in these states. Without the above formalities, there is no chance for a nurse practitioner to ever get credentialed to undertake practice. It is highly recommended for nurse practitioners in these states to have the necessary collaborative agreements in place when the need arises.

And finally, we have “Restricted.” This kind of practice states requires thorough supervision, delegation, or team management by an outside health discipline for nurse practitioners to practice health care.

Admitting Privileges

Many insurance plans require practitioners to have to admit privileges at an in-network facility. If a practitioner does not have the required admitting privileges then he/she need to prove an “admitting relationship” with another provider.

The requirement can be frustrating for many practitioners who work in a setting that does not have situations that require admissions requirement. As we mentioned, the “admitting relationship” should be in the form of a letter, on the letterhead of the concerned physician who states that the physician in question will handle all inpatient admissions for the patients when necessary.

There is no way you can skip this requirement. Nurse practitioners must keep this requirement ready when undertaking the credentialing process.

Credentialing File

It is highly recommended for nurse practitioners to keeps their files ready. All the credentialing documents and copies that will be required need to filed and available. Documents will always be needed for assessment, whether it is for credentialing or re-credentialing.

Here is a list of documents that you need for credentialing

• State License
• Current CV
• Professional liability insurance
• Current Drivers license
• Collaborative Agreement
• DEA/CSR
• Board Certificate
• Admitting Arrangement Letter
• Prescribing Arrangement letter
• Copy of diploma from the highest level of education.

Get Ahead of the Curve

Credentialing is not a piece of cake and can go on for a better period of a year. If you are starting a new practice or hiring nurse practitioners for your practice, then be ready with all the necessary documents and copies needed. Prepare a credentialing packet for your nurse’s so that they can arrange for the required documents without any confusion.

Let’s discuss the process of Banker’s life insurance credentialing.

Bankers Life insurance credentialing is a subsidiary of the very popular CNO financial group. CNO is a part of the fortune 1000 company list. As of 2019, Bankers life has around 1.4 million policyholders. It offers a variety of different insurance products like long term care, and life insurance, annuities, Medicare products including supplement lines, Medicare advantage plans, and Medicare part D prescription coverage and critical illness insurance.

Bankers Life Insurance credentialing has also partnered with Humana to provide vision and dental plans to their clients. They sell their plans with assistance from a network of over 5000 insurance agents based in over 320 offices throughout America.

As we mentioned, Banker’s life has over 1.4 million policyholders. Practitioners who want to tap into its client base need to get in-network with the credentialing process.

So let’s discuss the process of Bankers Life Insurance Provider Credentialing 

1. Getting Your Information in Order

As we mentioned before, Bankers Life insurance credentialing requires a lot of information and documents from the practitioner. They are:

• Licensure Information
• NPI Number
• Resume
• Proof of Malpractice Insurance
• Taxonomy Code
• Proof of Liability Insurance from Landlord (Applicable on if you are renting)
• Credentialing Paperwork

2. Fill Out Your CAQH

You will find many companies who use the Council of Affordable Quality Healthcare for the purpose of credentialing. Before filling out the CAQH form, you are required to hold an authentic resume with no gaps in employment. The application is supposed to be completed online via the CAQH hub.

The entire process can be extremely confusing to follow, but we at DENmaar assist you till the end.

3. Contact provider Relations

Once you have gone through the CAQH process, you are now afforded the liberty of choosing which insurance panel you want to be on. The insurance companies you choose may vary in the department of reimbursement rates, provider friendliness, payment speeds, etc.

Some companies may have their own sets of rules and requirements to apply. Now here you might face an issue of rejection, or not being accepted because the panel is full.

In such cases, you can do the following to build relationships with networks to gain access for future openings:

• Evening and Weekend Availability
• Experience with special populations
• Crisis services
• Handicap accessible facilities
• Being located in an underserved area
• Multilingual fluency
• Having an in-network referral source.

4. Submit Application

Once you have taken care of the documentation and decided on which insurance panel to join, it’s time to submit the application and wait. The entire process of getting paneled is relatively swift, culminating within 9-10 hours.

All you have to do now is a follow-up. You have to keep tabs on the status of your application. Chances are it might expire while still in the process if taken too long, and you don’t want to start again. The insurance companies have to be notified every time you submit a document to ensure it has reached them.

5. Review after Approval

Once you have received approval, it is still not an appropriate time to celebrate. Do the following to be on the safer side.

• Review your contract carefully before signing
• Keep a file with the agreement and any addendums ready for future reference.
• Learn more about the insurance provider’s portal on its official website.
• Collect a list of phone numbers for the claims department, pre-authorization department, and provider relations.

Being a Bankers Life 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.

Bankers Life’s network is extensive and harbors other insurance companies as well. You can get Meritain insurance credentialing, Coventry insurance credentialing services, etc. with the help of Bankers Life. 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 without complications and hassle so that you can work on other core areas of your medical practice.

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.