Let's talk a bit about why the contracting process requires zen level patience. On average, it takes three to six months to get contracted with each insurance company, with the latter being the more realistic time frame.
Why the lengthy process? Several factors draw it out: there are numerous steps and most aren't automatable, applications aren't viewed on a rolling basis by the companies, and unpredictable delays crop up along the way.
The "happy case"
Although each insurance company is different, the process will always follow the same general outline:
- You submit a letter of intent to join the network.
- IF panels are open, your CAQH profile is reviewed.
- You fill out a credentialing application. This will almost always include a form as well standard documentation like your W-9 and/or your state license, but some companies require supplemental information, like a diploma, that can take some time to locate.
- IF your credentialing application is approved, you’re sent a contract with an effective date (the date from which point you can see patients in-network and file claims). Remember though, the effective date is only valid after both parties have signed the contract.
- You sign the contract and send it back to the insurance company.
- The insurance company countersigns the contract and sends it back to you.
- You submit your demographic information as you would like it to appear in the company’s provider database.
- The insurance company loads the signed contract and your provider contact information in their systems.
Some unhappy scenarios.. and how we fix them
Many of the steps above are done manually by the insurance companies. We've caught some big errors in contracts (like incorrect tax ids and misspelled last names), so we make sure we review the contracts carefully—you should, too! Little incidents like this are fixable, but inevitably result in still more delays.
Applications for insurance companies are bulk reviewed on specific days, rather than being reviewed as they are received. For example, if Insurance Company A reviews applications to join the network on the 15th of each month and you submit your application on the 16th, your application won’t be viewed for an entire month. While this may be a more efficient way for insurance companies to process applications, it draws out the waiting game for you. As Healthy Bytes, we get applications in as soon as we can and follow up routinely, so we're up-to-date on these events and can try to expedite the process.
But still, there are the delays that can lengthen the timeline even more. For example, if Insurance Company B is set to review credentialing applications on January 22nd and there’s a giant snow storm preventing employees from making it into the office, that review gets pushed back possibly as late as to the next month’s review. Or perhaps, Insurance Company C has one person solely responsible for processing dietitians’ contracts and that employee goes on maternity leave. Often, nothing gets done in her absence (and by the time she returns there’s a substantial backlog on top of the already large volume of paperwork). As hard as it is to believe, these scenarios have actually happened to our dietitians.
There’s no way around it: contracting is a lengthy process. At Healthy Bytes, we stay updated on what's happening with your applications so you can focus on the good stuff, like seeing more clients or getting that website refreshed.
The increased number of patients you’ll be able to see as a result, and the overall positive public health impact you’ll be able to have, make the waiting game well worth it!