Registering & Contracting with Insurance Companies

by Britany
(Copperas Cove, TX, USA)

I am trying to get my own medical billing business started, mostly because I have a client already lined up. My question is, how do I go about getting registered or recognized or whatever with the different insurance companies?

The client I am trying to help is an orthotics/prosthetics provider, and has had trouble getting contracts with the insurance companies. Can you give some advice to the both of us?

Response:

The process you’re referring to is called credentialing - the process of applying to participate in or be contracted with an insurance carriers network. The application process can be pretty involved - especially if you have to go through the process with each individual carrier.

You can sign up individually with each insurance company. The forms or process is usually detailed on their website. Many allow the application process online or you can print the application out there. This can be a fairly time consuming process.

Not sure why your provider has had difficulty
getting contracted with the insurance companies other than the fact that the credentialing process can sometimes be intimidating and difficult to complete. And honestly I'm not familiar with the Orthotics specialty to know if there are caveats to getting credentialed. If the provider is not an MD or is a DME provider - that may cause some challenges.

There is a non profit organization called CAQH that's kind of a “one stop shop” for the application process. Many of the insurance carriers participate in it. Basically once you enroll with one insurance carrier the providers can participate in the CAQH Universal Provider Datasource. Then when you want to participate in another providers network, the insurance company can just access the providers info in the CAQH database.

Here’s more discussion on CAQH Credentialing.

Enrollment in Medicare requires completion of the 855I application available here - all 29 pages of it! Unfortunately anything having to do with Medicare usually involves lots of paperwork and waiting.

Medicare Enrollment - Completing the 855I on our Medical Billing Books page gives instructions on completing the Medicare process.

Hope this helps some. Hopefully others can comment (link below) also and offer more suggestions or opinions.

Thanks,

Gina