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Getting on an insurance panel as a preferred provider opens up your practice to patients and clients who wish to pay for your services with insurance. However, getting credentialed, as the process is known, can be tricky. Applications can run to dozens of pages and some hopefuls spend hours chasing lost applications, fighting enrollment rejections or sitting on hold with an insurance company that's not accepting panel members at the time. Figuring out what you can offer the insurance company, and not merely the patients, may make the process easier.
Visit the Council for Affordable Quality Health website. This online service allows psychologists and other healthcare providers to file their credentials and complete one application that most major insurance companies use in conjunction with their own procedures. To register, contact one of the universal providers listed on the CAQH website and ask to be invited. Once you receive your CAQH ID number, complete the application online.
Call the insurance company you are interested in and ask to speak with Provider Relations. Ask the employee to talk you through the application process -- make sure you understand what information you need to supply and when. Ask about the insurance company's unique clinical needs -- you stand a better chance of being appointed if you specifically address those needs. Request an application.
Check the insurance company's pay rates. If accepted onto panel, you must accept the insurer's contracted hourly rates for psychologists, which typically range from $60 to $160 or more. Make sure you're happy with these rates; if they are lower than your usual rates, you may have to write off part of your bill.
Complete your application. Focus on the benefits you can offer the insurance company, such as increasing efficiency and reducing costs. Include details of any languages you speak and any experience you have working with special groups such as children or deaf clients. Tell the insurance company if you have a handicapped accessible office or advanced training. Working extended or out of office hours can set your application apart from the many other applications the insurance company will receive. Psychologists that offer niche services, such as hypnosis or Eye Movement Desensitisation and Reprocessing may stand a better chance of success.
Prepare your resume, license, insurance documents, CAQH number and any other supporting information the insurance company requires. Keep copies for your records.
Send your application per the contact details on the form. Do this as soon as possible. Provider Relations typically reject applicant who do not submit their application or deal with queries in a timely manner.
Call your contact at Provider Relations to check they have received your application. Ask them when you will receive a response. Schedule a call or email to Provider Relations at least monthly until your application is resolved.
If your application is denied, ask for a single case agreement. This lets you work with a particular client despite not being a preferred provider if you can show that you are the best person to meet the needs of your client within the cost restraints of the insurance company. If the insurance company likes your work, they may transition you to panel.
The insurance company is more likely to admit you if you can serve an under-served area. Once you are on the panel, you can usually relocate back to your original location without losing your preferred provider status.
Check the requirements carefully. Some insurance companies only accept licensed psychologists with two or more years' experience under their belts.
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- All Things Private Practice: How to Register with CAQH:
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- All Things Private Practice: How To Get On Insurance Panels As A Preferred Provider – Part 2
- All Things Private Practice: How To Get On Insurance Panels As A Preferred Provider – Part 3
- Professional Practice Management: The Business of Psychology -- Insurance Panels: To Join or Not to Join
- Thrive Works: FAQ – Frequently Asked Questions about Getting on Insurance Panels
A former real estate lawyer, Jayne Thompson writes about law, business and corporate communications, drawing on 17 years’ experience in the legal sector. She holds a Bachelor of Laws from the University of Birmingham and a Masters in International Law from the University of East London.
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