Provider Credentialing & Contracting Checklist

Introduction

The first step to making sure your information is correct is to ensure that your contact information is up-to-date on each of your preferred carriers' websites. Then, you should request electronic copies of policies from each organization to make sure everything lines up properly. This checklist will help guide you through the process

Insurance Checklist

List of items that you should consider when approaching the insurance provider:

•   Check the type of coverage offered by the insurer, including any exclusions or limitations.
•   Get  A copy of the current rate schedule for your state (if applicable).
•   Markets the Insurance participates 

Know your Provider Relations Specialist

The provider relations department at an insurance company provides guidelines to healthcare providers. It is imperative that providers are familiar with their provider relations representatives so they can get help with specific issues.

Provider relations refers to the department at the insurance company to provide guidance to these providers. As a provider, it is imperative to know your provider relations representative. If you find any challenges in the insurance billing process, your provider relations representative is your go-to person. 

I find it important to maintain a good, solid working relationship with your Provider Relations Specialist.

The Right Taxonomy Code

The provider taxonomy code is a 5-digit code assigned by CMS. It is standardized and will not change over time, allowing providers to use it consistently when they're submitting claims.

State License Numbers & Expiration Dates

The following is a list of examples of state license numbers and expiration dates for each state where you are licensed to practice. make sure that the appropriate licensing agency has been updated with this information if it has changed since your last credentialing visit:

•   Alabama - 818-123456789
•   Alaska - 123456789

Hire An Expert 

There are numerous benefits of hiring an expert team like WWS when it comes to credentialing and contracting:

•   WWS can help determine which providers best fit your organization's needs based on their experience within the industry.
•   WWS can help find providers who offer competitive rates but still adhere to high standards of quality. If they have been working in health care long enough, they may even have worked with some providers before! (If not, they will be able to connect you with someone who has.)
•   WWS can take care of all paperwork so that there is less stress on staff members' time—and less chance for errors on those documents in general!

Conclusion

We hope that this checklist has helped you to understand the process of credentialing and contracting If you have questions or need help with your provider credentialing and contracting, don’t hesitate to contact us. We can help!