Session 170: How to Get Credentialed and Paneled and Mistakes to Avoid in the Process with Jeremy Zug

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Overview

No doubt you’ve heard questions—and experienced some confusion about how to get credentialed and get on insurance panels. We have had many questions about this topic in the STC community, so today’s show seeks to dispel some of the mystery surrounding this process.

Jeremy Zug, from Practice Solutions, works with clinicians with insurance billing issues. He handles your insurance billing problems so you can focus on providing superior care for your patients. In today’s conversation, we learn what “getting credentialed and paneled” means, we break down terms that can be confusing, and Jeremy walks us through the major steps in the process and the top mistakes that clinicians make.

What We’ll Learn

  • Getting credentialed and paneled (also called Payer Enrollment) is the process of showing and providing your credentials to an insurance company
  • The process includes your personal information, employment history, degree, license, address, and NPI–”It requires a specific process, but is shrouded in ambiguity.”
  • NPI–National Provider Identifier: sort of like a SS # for a provider who renders services. This number goes on every claim.
  • Steps to getting on a panel:
    • Gather all necessary documents to sign up for CAQH
    • Create or update your CAQH account
    • Acquire, fill out, submit, and follow up with applications
  • The application process is not unified and can vary from state to state
  • Some insurance panels require both Type 1 (specific to a provider) and Type 2 (group) NPI–and some require one or the other
  • Why organization is extremely important
  • The factors that influence who gets paneled are market saturation, your specialty, and the healthcare need
  • How reimbursement rates are connected to market saturation
  • Specialties that are looked at favorably are eating disorders and addiction specialists
  • How the political climate can affect the panelling process
  • If your application is rejected:
    • Use evidence-based modalities of treatment
    • Present the number of requests you receive that are already on this panel
    • Look at the number of self-pay patients you have
    • Learn great negotiation skills
  • Top 3 mistakes clinicians make in paneling:
    • Misinformation
    • Jumping the gun on seeing patients
    • Disclosing more than you need to

Resources

Find out more about Jeremy and Practice Solutions:  Practice Solutions

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Thank You for Listening

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