What is Re-Credentialing Management? – Renew your Insurance Panels

Great news! There is re-credentialing management services for providers. This service includes:

  • Re-attest CAQH on schedule
  • Update CAQH as needed
  • Manage contract renewals, including negotiating rates $$$
  • Ongoing customer support

If you’re a provider who is already on insurance panels, you know how beneficial this has been for your practice. You’re able to build your practice and turn away clients less because you accept insurance.

However, each insurance panel you’re on requires that you renew your agreement with them – this is the process of re-credentialing. Typically, this renewal needs to happen every 2-3 years. However, re-credentialing does involve playing a bit of a waiting game, so you want to stay on top of the process before it catches up to you.

Why Should I Undergo Re-Credentialing?

Failing to re-credential can cause quite a bit of hassle and inconvenience for you. If you continue to see clients after your agreement with the insurance panel has expired, you may be removed from the panel or even locked out permanently. Additionally, you will not be reimbursed for any services you provide during this period of time.

Re-credentialing is also a great opportunity to make sure that you’re being reimbursed properly for the services that you provide. It’s a great time to look at the fees the insurance panels are paying you versus what you do for your clients on a daily basis and to make sure that your compensation reflects what you do.

There’s no need to stress over the process—let an expert team handle it for you. If you’re looking for medical billing or credentialing help, consider our friends at East Meadow Management Group. They’re available to offer a timely quote, or help you find a solution. You can reach them at  516-277-8291 or by filling out this quick and easy form here.


Re-Credentialing Management Services

Here’s what an expert credentialing service can do for you:

1) Re-attest CAQH profile on Schedule:

Every 120 days, healthcare providers who works with 3rd party payers, are required to “re-attest” the information in their online CAQH profile. Failing to re-attest on scheduling, or failing to keep the CAQH database up to date can have negative effects on one’s ability to get paid by 3rd party payers. Subscribers are rest assured that a CAQH re-attestation deadline doesn’t pass unnoticed.

2) Update CAQH when Provider demographic changes take place:

CAQH needs to be up-to-date; this is the ‘cardinal rule’ for providers working with 3rd party
payers (like insurance companies). As you might already know, information in one’s CAQH profile is vast and includes easily overlooked items like: your current your Liability Insurance policy (which changes yearly), your address, your licensure expiration date (which changes yearly or bi-yearly), your resume, and more.

3) Manage contract renewals:

Many contracts with 3rd party payers (such as insurance companies or EAPs) are term contracts of about 2 years. When the contract is up, providers are often required to re-contract with a payer to prevent being unenrolled with the network (a painful and costly occurrence). Your credentialing team can help you manage your contracts and complete your renewal processes. They might even re-negotiate service rates for you (this is often overlooked and providers are often underpaid because they’re earning old rates that haven’t been adjusted for inflation/rising costs)!

***some have whole application process.
***you might get the renewal contract, not them.

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