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.
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.
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.
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.
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.
- Independent Blue Cross Group
- 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.Learn More
Aetna Insurance Provider Credentialing 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. To become a participant, however, healthcare services need to apply for Aetna Insurance Provider Credentialing.
Like we mentioned, Aetna medical Insurance Credentialing has an extensive network of people who subscribe to their health insurance. If accepted as part of the network, a medical service provider naturally becomes an in-network provider and people with Aetna plan will be more inclined to use their particular medical service.
The Process to Apply For Aetna Insurance Provider Credentialing
The entire process of applying to get into any insurance providers network can be long and complicated. However, it is necessary to tap into those clients who have insurance, thus making the process mandatory to run a successful medical practice.
1. Obtain a National Provider Identifier
The NPI, also known as National Provider Identifier, is a ten-digit unique identification number used to replace provider identifiers such as the unique provider identification number in HIPAA standard transactions.
Healthcare providers must obtain an NPI in accordance with HIPAA regulations. AN NPI should be obtained before applying to get into the Aetna network.
2. Request for Participation
Aetna requires any medical provider with interest in participating in their network to first submit a request for participation before filling up the application. This request is then later assessed by Aetna to determine a need for the participating provider in the area of their practice.
The request can be submitted online on Aetna’s website, or by contacting Aetna provider service center directly. It is crucial to have your medical office’s tax I.D and medical license number in hand during the process. After review, Aetna will send your provider agreement via e-mail for signature.
3. Join CAQH UPD
The CAQH Unique provider data source is an online tool that conveniently gathers information required by health plans to obtain provider credentialing. The CAQH registration process prevents providers from submitting the same information to multiple health insurance plans. The medical practitioners are required to login to the CAQH page to complete and activate the registration process.
4. Completing the Application
Once you have obtained the NPI, and have completed the registration process with CAQH, the next step is to authorize Aetna to gain access to your enrollment application and other information. The entire application now takes place online and can be completed in less than two hours. The Aetna module is designed to save your application form automatically if multiple sessions are necessary.
All supporting documents required for assessment should be submitted to CAQH. The documents needed are Curriculum Vitae, Medical License, DEA certificate, CDC Certificate, IRS Form W-9, Malpractice Insurance face sheet, etc. Aetna is very particular about who they include in their in-network. Their CVO uses strict guidelines to evaluate each medical practitioner’s qualifications, reputation, and competence.
Being an Aetna 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. Aetna’s network is extensive, and harbors other insurance companies as well. you can get Meritain health insurance credentialing, Coventry insurance credentialing services etc. with the help of Aetna. 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 and complications and hassle so that you can work on other core areas of your medical practice.Learn More