Once you decide that you would like to be on insurance panels and accept third-party payment for services, the next step is to get that ball rolling. That is the point where many folks put it on the “to do” list, along with the other things that seem too darn complicated. And there it sits. Don’t let this happen to you!
There is no doubt that getting yourself on insurance panels can take some time and effort, but it does not need to be complicated. The first thing I suggest my clients (I’m a Private Practice Mentor) do first, is to pull together all of the information they will need (over and over again) when making application to each of the insurance companies. Pull together copies of: your license and registration (or their equivalent, depending on the state you are in), your malpractice insurance binder, your degree (for some), and a copy of your resume.
Now is the time to go online to the Internal Revenue Services (IRS) website and get a federal Tax Identification number. Otherwise, the insurance companies will reference everything by your social security number. Even if you are not going to take insurance, you’ll want a Tax ID number to put on your “super bill” should a client request one (you don’t want to have to release your social security number to your clients).
Some insurance companies will provide a W-9 form (to use when they send you a 1099 form for your taxes each year) to complete and sign, but some will ask you to provide them with a W-9 of your own. You can find the blank form by searching the IRS website. Complete the W-9 online, and print out several copies for your records. You can sign and date them whenever you need one to include in your applications to insurance companies.
Now is the time to enroll with CAQH. Essentially, CAQH is a resource that insurance companies use to access your up-to-date information for purposes of putting you on their panels or renewing your provider status when required. Some insurance companies require that you register with CAQH as that is the ONLY way they will renew your provider status. You can do this on your own at the CAQH website, or with the help of a Private Practice Mentor or Practice Management Professional. CAQH is an article in and of itself. However, it is worth your time and effort to go online and read more about it. It is definitely something you should pursue if you plan to be on insurance panels.
Once you have everything you will need for your insurance company applications, you can determine which panels you would like to pursue. I usually encourage my clients to start by finding out which insurance companies are most prevalent in their practice location. Which HMOs, private insurance companies, and national insurance companies are insuring your (potential/existing) clients? Once you have that list, you have a decision to make.
Will you decide to pursue the insurance applications on your own, or will you hire someone to do it for you? Some of my clients want to be hands-on with every step; others recognize their time is worth money, or just don’t want to do it, so they ask me for a name of a local company that provides Private Practice Management support. The one I use charges only $75 per insurance company application and they will follow through and do it all for you. They will even do the market survey for you and provide a list of insurance companies that are most appropriate for your practice location.
If you decide to do it on your own, the next step is to go to each of the insurance company websites and download the appropriate provider applications. There are still a few companies that don’t have downloadable forms, but you can find the contact information for “provider relations” and request an application directly from them. You can search the site for the types of providers they panel and/or if their panels are open to new providers. This can save you a lot of time and wasted effort.
Then, simply fill out the application and sign in the appropriate areas. You will be asked to include the additional items required by the specific company, but since you already have your folder of items handy, it is just a matter of copying what you need and including them with your application. Be sure to photocopy the completed application before you send it in; put it in a folder for follow-up in 4-6 weeks if you don’t hear anything from them first.
There are certainly many related items that almost always come up in my coaching sessions involving getting on insurance panels. Things like accepting and/or negotiating fee schedules, billing procedures, authorizations, and other required paperwork are all just part of getting on board with the insurance companies. Once you get on panel, these are things you’ll need to know and understand to maximize your chances for uninterrupted reimbursement. You can do this with the help of the “provider relations” specialists with each of the insurance companies, or by working with a Private Practice Mentor. Each insurance company has its own set of rules; rules that determine how much and when you will be paid, as well as what you need to do to stay in compliance with your contract. Make sure to keep safe your executed contracts for quick reference.
Well, that’s my quick and dirty description of the process of getting on insurance panels. Good luck to you!