Getting on Insurance Panels: Opportunities and Challenges for 2013

Getting on Insurance Panels: Opportunities and Challenges for 2013

As we approach the New Year, our credentialing team is being asked more and more frequently what 2013 will bring for the process of getting on insurance panels.

That’s a good question! While we don’t have a crystal ball, the trends show us a lot. Here are our predictions for 2013.

  1. 2013 is a transition year.
  2. 2013 is the credentialing equivalent to the iPhone 4S, that awkward transition between the iPhone 4, and iPhone 5. The big national healthcare reforms come into effect in 2014, not 2013. However, we can expect insurance companies to start altering their processes and general policies, in 2013, in preparation for the big changes.

  3. Panels Will Open.
  4. If you are a provider residing in an urban area, perhaps one of the most desirable panels in your neighborhood is closed. Despite your years of experience and stellar track record, you can’t even get an application from the insurance panel. Why? Because bringing on and managing providers costs insurance companies money, and therefore insurance companies only enroll the number of clinicians they need to serve their patients/customers.

    Well, good news for you! 2014 is going to bring a flood of newly insured patients, each with mental health parity. Because of this, it is reasonable to expect that even the tightest of insurance companies will start opening their panels around mid 2013, to prepare for the flood of patients they will have in 2014.

  5. The Application Process Won’t Get Any Easier.
  6. As a healthcare provider, you know better than most that “change is hard.” You likely learned this the first time you tried to help a patient adopt a healthier lifestyle. Throughout 2013, we can expect that insurance companies are going to be revising their enrollment processes to accommodate more applications from providers, and to comply with 2014 healthcare reform. Actually, it’s already starting. As it comes to enrolling with insurance panels in 2013, expect a few bumps in the road.

  7. New Insurance Companies will Form, Companies will Intertwine.
  8. We have already seen it on a smaller scale. In Massachusetts, which has been a type of test kitchen for the nationwide reform, a number of new insurance companies have appeared, and existing insurance companies have formed a confusing web of connections.

    For example, here is a short inner-company email blurb from Thriveworks Billing department, explaining the insurance web with “MassHealth” in Boston.

    “When someone has MassHealth they usually are covered under MBHP (Massachusetts Behavioral Health Partnership), or Commonwealth Care.  Commonwealth care consists of Network Health, NHP (Neighborhood Health Plan, which is also Beacon Insurance) and Celtic care (and there may be others). Someone can also be Network Health Commonwealth Care, or Network Health MassHealth. We need to ask clients for lots of details.”

Final Word

All things considered, even if the credentialing and billing process will become a bit more complicated, with the likelihood of insurance companies opening closed panels, we thing 2013 is going to be a good year for providers looking to get on insurance panels.

If you are looking for help Getting on Insurance Panels, or assistance with Medical Billing, contact Thriveworks at 1-855-664-5154, or find us online.

Counseling Private PracticeDr.  is CEO of Thriveworks, is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at http://thriveworks.com/counseling-private-practice-book/

Looking for help starting or growing a private practice? We can help! Learn more at http://thriveworks.com/private-practice

872 Massachusetts Ave
Cambridge, MA
Phone: 1-855-2-THRIVE
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