Welcome back to The Claim Game! In this episode, Jeremy and Kathryn Zug zoom into the first critical "territory" on your Revenue Cycle Management (RCM) game board: Credentialing. This process is your entry point to accepting insurance, and understanding its nuances is key to your practice's success. The Zugs break down the decision between handling credentialing yourself (DIY) or outsourcing to a specialized service, exploring the pros and cons of each approach to help you choose the best path for your practice.
They then guide you through the six stages of the credentialing journey:
Stage 1 - Information Gathering: The foundational phase of meticulously collecting all necessary practice and provider data, often utilizing platforms like CAQH.
Stage 2 - Application Completion & Submission: Filling out forms with painstaking attention to detail, ensuring everything matches your supporting documentation.
Stage 3 - Application Follow-Up: An active and ongoing process of consistently tracking your application's status, confirming receipt, and proactively resolving any flags or denials.
Stage 4 - Contract Finalization: The crucial step of carefully reviewing and understanding your payer contract's terms, responsibilities, and compensation details before signing.
Stage 5 - Start Date Establishment: Understanding that your official in-network status begins on your effective date, not just upon contract signature.
Stage 6 - Manage & Review: Recognizing that credentialing is an ongoing cycle, requiring regular recredentialing/reattestation and updates to your information.
Even if this sounds like a lot, Jeremy and Kathryn assure you that understanding this "bedrock" process empowers you to navigate it successfully and build the practice you envision.
