Credentialing – the challenges we face

Enrollment…Revalidation…Deactivation…Contractual obligations…
If you are a healthcare provider, these are the words that you have definitely encountered at least once in your career. Proper credentialing is a vital aspect of the revenue cycle management process. Not only does it impact the patient flow of your medical practice, but it can also strongly influence your overall reputation as a healthcare provider. It is beyond obvious that being active with as many insurance carriers as possible attracts more patients and that keeping your license and billing privileges in good order is critical to demonstrating your professional competence.
Since 2001, we have witnessed an alarming tendency. Day by day, insurance payers become more attentive and selective when it comes to cooperation with healthcare providers. While some payers are reluctant to open their participation panels, others have implemented an extremely complicated and time-consuming enrollment process. More importantly, since the beginning of the COVID-19 pandemic, we have seen many major insurance companies violate their own codes of conduct, causing revenue losses to hundreds of healthcare providers. Today, we would like to shed light on the most outstanding credentialing-related issues that we have recently experienced with commercial insurance carriers.
But where there is a problem – there is always a solution!