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:
· Applying provider is in good standing with state and federal regulatory bodies.
· Applying Provider has been reviewed and approved by an accredited body.
· Every three years is still in good standing with state and federal regulatory bodies and is reviewed and approved by an accredited body.
· Liability insurance coverage is maintained.
· Copy of facilities State License.
· CLIA certificates are current.
· 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 providers 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 process.
The Process to Apply For Humana Health Insurance Credentialing
1. Pre Application
Before applying, Humana Health Insurance Credentialing requires practitioners to handover some necessary information to confirm that the applying practitioner is meeting 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 of 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
· 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.Learn More
Addiction Treatment Credentialing have become absolutely necessary for medical practices who have taken it upon themselves to combat the crisis of substance abuse disorder.
The Addiction fighting workforce today is represented by at least 100,000 counselors, healthcare professionals, and educators. These professionals help in the treatment, recovery, and support of individuals suffering from substance issue problems.
However, rendering of such treatment and recovery process becomes impossible for medical professionals if they fail to get credentialed with government or private medical agencies like Medicare, Medicaid, Aetna, etc. Private and group practices cannot offer addiction treatment or collect payments from patients who are covered by the federal insurance program.
Addiction Treatment Credentialing – What is it?
Credentialing is the process of assessing the legitimacy and background of a medical practitioner and establishing the qualifications they require to become licensed professionals. The concept is simple and is designed to protect ailing individuals from being exploited by fraudulent practices.
With the help of Addiction treatment Insurance credentialing, healthcare professionals have the necessary license requirements to legally serve new patients and get paid by these patients for the services they perform.
Why Get Addiction Treatment Insurance Credentialing
Rising Substance Abuse Disorder (Crisis)
The crisis of addiction our nation faces today is the stuff of nightmare. In 2017 alone, 70,000 Americans died of a drug overdose. This includes prescription opioids, heroin, and illicitly manufactured fentanyl abuse. The death rate has gone up from 6.2 per 100000 people in 2000 to 14.2 per 100000 people in recent years.
The numbers signal the imminent demand for Medical practitioners who have the skills and qualifications needed to provide medical attention to a population of people suffering from Substance Abuse Disorder.
Probably one of its vital benefits is how it can get a medical practice onto an insurance panel, or better yet turn them into an in-network provider. This allows for dealing with billing codes, rates, and other reports and deliverables consistently. The overall uniformity this system offers can help healthcare enterprises make essential decisions more effectively and efficiently.
Better Customer Support
As many insurance companies, today have their own team of autism specialists, in-network providers such as licensed medical practitioners have the chance to socialize and build valuable relationships within the organization that can help with faster claim resolution, or helps resolve queries regarding claim issues. This allows for pre-authorization, re-authorization, and claims information online. All of these factors ultimately enable clinics to provide better customer support to their customers.
Getting credentialed allows medical practices to send bills to insurance providers electronically. Electronic claims are a faster, more convenient way of receiving payments quickly than traditional paperwork. Unfortunately, this benefit cannot be enjoyed by medical practices that don’t possess the necessary credential requirements.
The Process of Getting Addiction Treatment Credentialing.
The Addiction Treatment Credentialing process is a long and complicated one. The whole process can take between 90 and 120 days to culminate. It is highly recommended that the credentialing process be started as soon as possible, especially for new medical practices.
You also have to be ready to take 45-minute calls every day while your application is under process. Hence due to its length of time and complicated nature, it is highly advisable to seek the help of third-party support like denmaar who can get the job done for you.
The following is the process to get Addiction Treatment Credentials.
1.The first step towards getting credentialed requires medical firms to apply for an NPI aka National Provider Identifier. An online application requires the input of information like social security number, BCBA certificate number or BCaBA certificate number, Taxonomy code for behavioral analysts, and BA license number if applicable. The NPI is usually acquired within a day and is essential to receive reimbursements for ABA services with any carrier.
2.After the acquisition of NPI, the next step is to become a member of The Council for Affordable Healthcare. A medical practice can only become a part of CAQH. The medical practice needs an invitation from the insurance provider. Once the firm can log in to the CAQH system, they are required to submit a plethora of information such as employment history, references, resume, and W9, BCBA, or BCaBA certificates, educational history, information about medical practice.
3.After the application is completed, insurance companies will have access to the information provided. They will use the information to verify it with their agency.
Stop Losing Patients with Insurance
Medical practices need to be privy of all the plans and terms of coverage offered by insurance companies. Almost all Americans are enjoying the benefits of some of the other health insurance programs. Without the necessary credentialing requirements, there is no point in even starting a medical practice that treats addiction, no matter how noble your intentions may be.
Addiction Treatment Insurance Credentialing is essential for medical practices to continue to accept new patients and receive payments to justify their services. The process to get credentialed can be tedious, a problem that can be alleviated by hiring third party professionals like denmaar who can do the heavy lifting for a medical practice.Learn More
Given the lengthy, tedious nature of Affordable Insurance Credentialing Services the question that most physicians and medical practitioners are left with is if there is such a thing as Insurance Credentialing. Most of the cost incurred during the Insurance Credentialing is directly related to the time that physicians spend in the process.
The typical duration of the entire process is around four months. During these four months, the medical practice has to go through a variety of steps to get the credentialing process right. Frankly, it varies according to various factors.
The Affordable Insurance Credentialing Services may vary based on:
· Current Credentialing Service
· The number of physicians needed to be added.
· How quickly you grow your practice.
· Changes in insurance contracts
· Additional services rendered from the credentialing service provider.
One way to estimate the Affordable Insurance Credentialing Services cost in 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 a $100/hr, pay, 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 $20000/year. Insurance Credentialing cost way less when outsourced to a third party like Denmaar.
Credentialing Cost Breakdown
Individual Physician Cost – 100-200$ per physician
Initial Setup Cost can go up to $200-$500
Panel Application Cost
Physicians should expect to pay $100 per panel
So, on an average, the general cost of Affordable Insurance Credentialing Services is somewhere between $2000-$3000/ year.
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.
This is why third-party Insurance Credentialing are so essential in getting on insurance panels. 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 alerted of your status application in real-time.
Affordable Insurance Credentialing Services can be availed only when you outsource them to companies like Denmaar.
Fill the form below or call now on 1-888-595-5100 to get a free estimate.Learn More
Psychologists Insurance Credentialing Services and counselors have become extremely important today. Psychologists, just like other practitioners, need to go through an extensive credentialing process to validate their practice.
Mental health specialists have become an integral part of the modern society reeling with record high numbers of people suffering from a mental ailment of one form another. Psychologists Insurance credentialing Services need to have access to insurance panels to continue to cater to clients covered under the federal insurance program.
Below are some reason why Psychologists Insurance Credentialing Services is vital.
If you are a professional working for a firm or a group practice then, of course, you can get away with not getting credentialed as your firm is already an in-network provider. But what if you want to start your own practice? In such a scenario, not having the valid credentials will pinch. Having the necessary Psychologists Insurance credentialing Services requirements helps individual psychologist tend to clients who are covered under the federal insurance program.
Not long ago, it was the norm for psychologists to rely on PPO’s (preferred provider options) being used by their new clients. This allowed psychologists and counselors to avoid the need for being on insurance panels.
However, today, HMO’s are used more extensively than PPO’s, which have become very rare. PPO’s simply isn’t financially viable anymore, and practice will incur fines and penalties for using PPO’s if you are out of their network.
Our times are different than our predecessors. The affordable healthcare act launched by the US has created an amicable environment where everyone can afford to see a counselor. This is excellent news for counselors on insurance panels, and not so much for those relying on the cash-based system.
With cries for more progressive healthcare policies like Medicare for all becoming deafeningly louder, it is beneficial for Psychologists Insurance Credentialing Services to get in-network with insurance panels.
Panels are closing
Many group and private practices are vying for the same panels at the same time. This is leading to many reputed and well-known insurance panels rapidly closing down. The competition is just too intense. Insurance companies cannot afford to be in-network with everyone as it is just not financially viable for them. Hence, jumping at the opportunity sooner than competitors is important.
Just like other practitioners, psychologist credentials with insurance companies need to get in-network. With universal healthcare, they simply cannot afford to lose clients that are on insurance programs. Getting on insurance panels is crucial for Psychologists Insurance Credentialing Services and counselors to accept new clients and expand their practice.
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 any complications and hassle so that you can work on other core areas of your medical practice.Learn More
BCBS aka Blue Cross Blue Shield Association is a widely recognized federation of 36 separate Health Insurance organizations, and Companies. This association, which includes different well-known insurance providers, covers more than 106 million citizens in America. Publicly traded and privately owned insurance companies like Anthem, CareFirst, Highmark, Premera, Cambia Health Solution etc. are all part of the BCBS Insurance Credentialing Services.
As such, applying for BCBS Insurance Credentialing Services is crucial for practitioners who seek to tap into the pool of potential clients who are covered by the Blue Cross Blue Shield Association. Now, becoming an in-network provider is a three-part process. It is lengthy and fairly complicated. It is advisable for group and private practices to seek help from third-party credentialing service providers like Denmaar to simplify the entire process.
Let us look into the process of applying for BCBS Insurance Credentialing Services :
As mentioned before, becoming an in-network provider with BCBS is a three-part process.
· Getting Credentialed or Re- Credentialed
· Register Your NPI (National Provider Identifier)
· Have a Signed Contract with BCBS in your state.
1. Getting Credentialed
BCBS first checks the credentials of medical practitioners who apply for Insurance Credentialing Services. They have to submit their resume, work history, and other vital information for the purpose of background verification. The applying party can send their applications and documents online or manually.
· Online application with BCBS Insurance Credentialing Services is only exclusive to providers. The information is sent to the Universal Credentialing DataSource (UCD). BCBS works closely with the Council of Affordable Quality Healthcare, thus making the entire process quite simpler.
· Facilities who are not providers have to send their applications manually.
2. Obtain an NPI (National Provider Identification Number)
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 BCBS network.
3. Get a Signed Contract
Before getting a signed contract with the BCBS Insurance Credentialing Services you have to register your NPI Through the enrollment application process, register for Blue e to be able to access Explanation of Payments (EOP), and sign an EFT to receive claims payment.
The entire process can take 30 – 45 days from the date of NPI enrollment. All you do now is wait.
As you can probably guess by now, becoming an in-network provider with BCBS Insurance Credentialing Services 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. There is also a higher risk of application rejection when you go about the BCBS Insurance Credentialing Services process alone.
That is where the professional assistance of Denmaar comes into play. With the help of our BCBS Insurance Credentialing Services 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.Learn More