Why would I want to be credentialed?

Since the Affordable Health Act, we are seeing more and more that deductibles and other out of pocket expenses for patients vary greatly between in vs. out of network providers.  Being in network ensures that your patient pays the least amount of out of pocket costs, keeping them in your office and not going down the street.

What is credentialing?

The process of credentialing is stressful, confusing, and frustrating. Working with us can alleviate much of that stress! We’ll do the research for you. We have personal relationships with many of the major insurance companies, and can help you get in-network with the companies that will benefit your practice most.

Sounds great! What is the step-by-step process?

The basic rundown is:

  • We gather your information. A straightforward form for you to fill out – no byzantine structure or questions meant for other practitioners. Written just for Alternative Health Care Practitioners, it gathers only the information we need to get you in-network quickly.
  • We’ll set up, correct, and complete your CAQH account.
  • Once your CAQH account is finalized, we’ll fill out and submit your applications to the insurance companies of your choice.
  • Then, we follow up and navigate any problems that might arise during the process until you’re done! Feel free to ask for a progress report any time you feel antsy.
  • Keep in mind, sometimes insurance companies are SLOW. We keep things moving as fast as possible, but it still takes time.

Which insurance companies should I get in-network with?

That’s a great question – and one that varies, depending on your needs in your practice. If you’re trying to grow your practice and get patients in the door, we recommend getting in-network with as many companies as you can. This will result in more patients being referred to you by insurance companies.

However, you may have a practice full of patients who mostly use a few insurance companies – Blue Cross or Cigna, for example – and you like how those companies pay. This gives you the freedom not to work with a particular third party payor. Or maybe you’ve decided to end your relationship with a company because you don’t like their requests for supplements, etc.

Call us! We’re happy to have a conversation with you about your needs, and help you decide which insurance companies you want to be credentialed with.

What costs are involved?

At Alchemy Credentialing, we determine costs state by state. Many states have up to 20 carriers that you may want to be in-network with, while others may have only a few. The fees for credentialing services include having your own Credentialing Manager: an educated, hard-working facilitator who is all yours. We stay current and educated on the specific credentialing needs for your Alternative Health Care Specialty in each state. We have personal contacts in many insurance companies nationally, and can get up-to-the-minute information about where you are in the credentialing or contracting process.

What are some of the more popular insurance companies?

What is popular in your area may vary greatly, but it’s usually a good idea to get in-network with major companies that tend to service larger areas. These include Blue Cross, Blue Shield, Aetna, Cigna, United Healthcare, Humana, Coventry, Highmark, Health Net of California, Kaiser, and others.

What about Workers’ Comp?

In most states, workers’ comp is a simple registration with the insurance provider and does not require credentialing. Let us know if you’re having trouble – we may have a few tips on getting you registered with them.

How long does the credentialing process take?

Once we get all of your information, we will carefully and quickly complete and submit your applications to insurance companies. After that, it can take from 90-120 days, depending on the carrier. We’ll follow up regularly with our representatives in each company to make sure your application is processing smoothly and clear any problems that may occur.

How many hours of my time am I saving by having you do my credentialing?

We devote personal time to you and your practice while you gather information, fill out and submit applications, and then follow up. Each company you choose to credential with takes us about 10 hours.

Am I guaranteed to get on the panels that I apply for?

Generally speaking, there will be plenty of insurance companies with whom you can be credentialed. In some areas, panels can be closed to alternative health care professionals, but we’re happy to put you on the waiting list for them.

How can I track the progress of my applications with the various companies?

We’re happy to give you an update any old time you wish – just contact us. In general, we’ll provide you with updates on a regular basis without you asking. If you have a specific request for any company, just let us know.

Do you provide billing for acupuncturists?

We sure do! Acubiller provides full-service billing that is very personalized. Call Eliza – she’ll answer all of your acupuncture billing questions and get you started!