DENmaar: Streamlining Clinical, Administrative, and Billing Operations for

  Why is the Insurance Credentialing Process So Long?

Thanks to credentialing, any newly hired health professional cannot start work at their new facility for the initial few weeks to six months. Normally, it shouldn’t take providers more than 3 hours as all they have to do is gather all necessary documents and submit them. 

For the facility staff, however, this process can be excruciatingly long. They are responsible for executing several crucial tasks, which include:

• •     Launching a Background Check
• •     Gathering and reviewing the health professional’s credentials, past reputation, and case history. 
• •     Reviewing claims, board history, and privileging
• •     Check sanctions with OIG (Office of Inspector General)
• •     Perform primary source verifications such as medical boards, education history, etc. 
• •     Present files to facility stakeholders, credentialing, and executive committees.

The process has to be repeated every time a new provider is to be credentialed. This makes insurance credentialing extremely frustrating. Communication is often a problem during the execution of these processes and the fact that each facility has its own way of spearheading the credentialing process, makes it even more challenging. 

Other factors, like incorrect or missing information in the application, can delay the process even further. If the credentialing board has a stuffed schedule, then you can expect further delays. As such, you can now understand why many health professionals and institutions consider credentialing to be a never-ending headache. 

  How Much Does Credentialing Cost?

One way to estimate Insurance Credentialing Services costs is by calculating the time a physician would spend on the actual credentialing process. On average, that would be 43 minutes per day.

Now, if we assume that a physician works on $100/hr, that’s approximately $20000/year in credentialing work per physician. This is excluding any paperwork; of course, you lose more money if you lose relevant documents.

In hindsight, you are spending way more than $20000/year. Medical Insurance Credentialing costs way less when outsourced to a third party like DENmaar. Refer to the below breakdown to understand – how much does physician credentialing costs?

Credentialing Cost Breakdown

Individual Physician Cost – 100-200$ per physician

CAQH Database

Initial Setup Costs can go up to $200-$500

Panel Application Cost

Physicians should expect to pay $100 per panel

So, the average cost to credential a physician is somewhere between $2000-$3000/per year. The average cost to credential a nurse practitioner will be more or less the same as well. 

  Why does Credentialing Cost So Much?

Most of the cost incurred in the process of credentialing is because of its lengthy nature. You lose money if you lose your documents. You lose money if you fail to follow up with the insurance companies, resulting in the expiration of your application. The entire process has too many pot-holes for medical practices to crash and burn.

An average physician can lose thousands in income due to this process. Let’s say that a physician makes $299,000. Waiting to render their services for a few weeks due to credentialing will cost them around $25000. Even worse, waiting for six months could cost them an income of around $150,000.

The problem isn’t limited to a few healthcare professionals. In fact, the entire healthcare industry loses billions every year in the USA due to an inept credentialing process. Fortunately, there is a way to avert this disaster and make the credentialing process more cost-effective. 

  Perform Credentialing in a Better way with DENmaar

Credentialing doesn’t have to be as time-consuming or costly as it has been for a long time. All you need are the right credentialing experts shouldering the responsibility on your behalf. This is where DENmaar’s insurance credentialing services come into play. 

DENmaar is home to the credentialing experts, resources, and insight needed to expedite and execute the entire credentialing process in an effective and efficient manner. 

DENmaar offers a fully automated system that provides practitioners with end-to-end solutions to credentialing. You are automatically updated about the status of your application. You get automated re-validation alerts, are assisted throughout the CAQH form filling process, and are alerted of your status application in real-time.

Affordable medical Insurance Credentialing Services cost is possible only when you outsource them to companies like DENmaar.

Fill out the form below or call now on 1-888-595-5100 to get a free estimate.

You have just started a new practice, and you now want to learn about the process of Credentialing Doctors to your group practice. There are many questions that storm the mind before the inception of such a process. Where to begin? Whom to approach? What insurance panels to choose, or how to panel with an insurance company?

The question can be baffling and complex, but not as complicated as the process itself. Those who have undertaken the process know-how stretched out and overwhelmingly complex it actually is. With lots of paperwork, constant follow-ups, and increased risk of loss of documents, it is one hell of an undertaking; many practices wish they would never have to go through. Thankfully, there are third-party Insurance credentialing service providers that can help you immensely with the entire dreadful process by avoiding all of its hassles.

Let’s look at some of the main questions that practices have with regards to insurance credentialing for physicians.

How to Know Which Insurance Companies to Panel With?

You start by asking your colleagues in the same field, or the providers in your own locality about which insurance they are using. Find out all the pros and cons of the insurance companies from them like their rates, promptness of payment, etc. Know which physician credentialing insurance companies are popular in your locality, and which have the most clients’ coverage.

Should You Set Up a Group Contract with Insurance Company?

Some insurance companies allow group contracts, and some don’t. It varies from one company to the other. What is more important to consider is that your clinicians get credentialed using the practices NPI2 and tax ID, and not their own social security numbers. You don’t want to chase all of your clinicians for the checks that were supposed to come to you. Let your clinicians fill out their w9 form with your name, TIN, and address, so insurers know to send the checks to you and not them.

Another benefit of applying as a group is that it is easier to negotiate rates this way than it is to negotiate to be a solo provider. Also, the process of adding clinicians is easier and less time-consuming.

What to do once clinicians have completed their application to participate?

Documents get lost all the time during the process of credentialing. In such a scenario, it is important to follow up with the provider relations departments regarding the receiving of a document. Follow up every week, but do not do it constantly so as not to annoy the already irate officials.

Like we said before, the entire credentialing Doctors process is not without its hassle. We would suggest putting together a Credentialing packet for all your clients with all the credentialing Doctors related information they will need. This will make the entire process easier as every entering therapist will have the knowledge needed for their individual credentialing requirements.

With the help of Denmaar’s credentialing experts,we can walk you through the entire process without any complications and hassle so that you can work on other core areas of your medical practice. You deserve the best physician insurance credentialing services, and we know how to deliver it.

Humana Provider Credentialing & Contracting Services

Join Humana as an in-network healthcare provider and expand your services to a wider base of patients with our Humana Insurance provider credentialing services. 

Let’s discuss the Humana Health Insurance Credentialing Process. 

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.

The following elements are crucial for a practitioner to be credentialed by Humana:

1. Applying provider is in good standing with state and federal regulatory bodies.
2. Applying Provider has been reviewed and approved by an accredited body.
3. Every three years is still in good standing with state and federal regulatory bodies and is reviewed and approved by an accredited body.
4. Liability insurance coverage is maintained.
5. Copy of facilities State License.
6. CLIA certificates are current.
7. Completion of a signed and dated application.

As mentioned, Humana has at least 13 million Americans covered under its insurance program. Hence, it makes sense for Humana health insurance provider credentialing to get in-network with humans to tap into what could potentially be a lucrative market. The process, however, is overwhelmingly tedious with too many moving parts. Thankfully, DENmaar’s team of experts will help assist you throughout the Humana credentialing process.

Check out Credentialing Process Checklist.

The Process to Apply for Humana Health Insurance Credentialing

The provider credentialing process for Humana is as follows: 

1. Pre Application

Before applying, Humana physician Credentialing requires practitioners to handover some necessary information to confirm that the applying practitioner is meeting the basic guidelines of Insurance Credentialing with Humana. A Humana 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 Humana’s Health Insurance Credentialing guidelines, they send an e-mail with an application packet containing all the information needed to get started.

If the application information already exists on the CAQH aka Council for Affordable Quality Healthcare exists on the CAQH or One Health-port website, then Humana will with the applying parties’ permission, proceed to access it electronically.

The Following application information is required from the applying party, depending on:

• •     Active and Unrestricted License in the State
• •     Drug Enforcement Agency Certificate (If Applicable)
• •     Good Standing With Medicare and Medicaid, Medicaid Number
• •     Humana participation in-hospital clinical privileges
• •     letter of interest for insurance credentialing for Humana
• •     Board Certification Status
• •     Professional and Educational Training
• •     5 Year of Work History
• •     Malpractice Claims History
• •     Adequate Malpractice Insurance
• •     Prior Sanctioning Activities

3. Follow Up

Once Humana receives the application packet, they will start the credentialing process. The entire process will take 45 to 60 days to complete.

During this time, the applying party 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, Humana 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. Humana Approval

If Humana approves a particular practitioner’s application, the practitioner becomes an in-network provider with Humana. Humana will update the provider information in their database within the next 10 business days.

Being a Humana in-network provider although tedious, is essential for providers to get clients who are covered under the Humana Insurance program. We at Denmaar, understand that medical practices would rather focus their energies on treating their patients rather than focus on the tedious task of credentialing. Hence, we offer a robust end to end credentialing solution that assists you throughout the process.

DENmaar’s Insurance Credentialing Services and its Benefits

The following are the major benefits you can enjoy by availing of our Humana Provider credentialing services. 

1. Access to Credentialing Specialists

We are home to highly skilled credentialing specialists who are with you from start to finish to make sure your credentialing process with Humana goes smoothly, without any hiccups. 

2. Expiring Document Alerts

We arm you with personalized credentialing software that promptly alerts you of expiring documents so you can take the necessary steps before the set deadline. 

3. Up-To-Date CAQH

CAQH is an integral part of the healthcare credentialing process. At DENmaar, we help you create, update, and keep your CAQH relevant. 

4. Automated PAR Status Updates

Be up-to-speed about your application’s status at each and every step of the Humana credentialing process with DENmaar’s special RCM portal. 

Who We Help with Insurance Credentialing & Enrollment?

We simplify the insurance credentialing & contracting process for the following entities.

• •     Physicians
• •     Physician Assistants
• •     Nurse Practitioners
• •     Urgent Care Facilities
• •     Audiologists
• •     Behavioral Health Providers
• •     Physical, Occupational, and Speech Therapists

Join Humana as an In-Network Provider with DENmaar

Humana contracting and credentialing is no child’s play. At DENmaar, however, we are home to Humana credentialing specialists who possess the experience, skills, and resources needed to help you get credentialed with Humana in a quick and efficient manner. We make sure all of your documentation is taken care of to make sure your submitted application has a chance of being rejected. If by any chance your application is denied, you rest assured that our specialists will do the necessary and resubmit the application in time to boost your chances of getting credentialed with Humana.