Submitted on Wed, 2013-10-30
By SMART Health Claims

Two important steps for expanding or starting your health department's billing program.

Insurance Credentialing & Insurance Contracting

If you’re a local health department looking to expand upon or start a billing program, chances are you’ve heard the terms “Credentialing” and “Contracting” before. Without completing these two very important steps, you won’t be able to bill private insurance companies for the services you provide, missing out on a huge source of revenue. But what does credentialing and contracting entail and where do you start?


Insurance Credentialing

Local health departments can only begin billing private insurance companies after they have been credentialed. It is a process used by private insurance companies to obtain, verify, assess, and validate a health clinic in order to make sure they are a reputable facility and for liability purposes.

To begin the credentialing process, start with a file folder for each insurance company. Since they will all require different forms and documents, this will help you organize and simplify the credentialing process for each payer. To compile a list of insurance companies to get credentialed with, we recommend surveying your clients to see which insurances are used the most. Start with the most common ones at first.

After you have the list of insurance companies to get credentialed with, you’ll need to find out the requirements for each company. Do a simple Google search for “INSURANCE COMPANY Credentialing” (where you replace INSURANCE COMPANY with each company’s name). That will get you to the web pages that run down each company’s credentialing requirements and forms. From the web pages you find, gather all the relevant information you need and fill out the forms and documents they provide. Submit the forms, and you should be credentialed within 90-180 days.

Now that you’re credentialed, you can move on to contracting with each company…

Insurance Contracting

Contracting is the process of setting up agreements with the insurance company to become in-network with them; establishing rates, services covered, the time frame a payment will be received, and other information with each individual payer. You’ll need to set up a separate contract for EVERY insurance company you plan to bill.

Much like credentialing, you can Google each company to find contact information, but contracting is a much harder process. You will have to negotiate with insurance companies and it’s highly dependent on talking to the right person within the organizations. Learn more in our previous blog post: How to approach private insurers about contracting.

You can also talk to other local health departments to get tips and contact information from them, or work with a third party that has experience and knowledge in the contracting process.

Contracting and credentialing require research, time and a lot of detailed work. Working with a third party has many benefits since you are able to leverage their existing relationships with insurance providers. Upp Technology has public health consultants on-staff that are well-versed in the entire billing process. You can rely on our knowledge and experience to help you set up a successful billing program. Give our public health consultants a call today so you can get credentialed, contracted and on your way to billing faster.

Innovative Technology Solutions