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Stop the Credentialing Madness on the payers side!

Friday, December 12, 2014
Stop the Credentialing Madness on the payers side!
From the time WCH credentialing department was developed in 2001, many providers and healthcare practitioners benefited from excellent credentialing services. In the past 14 years, WCH credentialing team has grown to be an experienced and professional team that serves healthcare professionals nationwide. With constant new government regulations and insurance change, WCH credentialing team has always been on top of all challenges, in order to provide fast and accurate service. However, our job is becoming increasingly more difficult, due to enormous amount of mistakes that are made on the insurance side. Many processes become longer; insurances have downsized their credentialing department or fully outsource their workforce which results in disruption of the processing of applications.
WCH has enough expertise and experience to realize that there is major chaos in the credentialing world, almost in every payer enrollment department. From our work with insurance companies, here are some of the issues we have seen occurring over and over again. We share our experience with you: Major issues in Medicare Credentialing Department:
• Errors in application processing: Closing application incorrectly, assigning wrong provider numbers, linking providers to wrong groups, closing PECOS applications without any reason.
• Frequent and rapid staff change: Difficult to get to speak with knowledgeable representative that handles an application from beginning to end.
• Closing applications without site visit and for other inaccurate reasons.
Major issues with other Payers:
• Panels are closing and/or insurances are giving preferential treatment
• Urgent Care centers are being purchased by insurance companies, limiting new centers from joining and opening up
• Simple demographic updates that normally took 30 days now can take up to 180 days to process, you can only imagine what is the time frame for more complicated cases
• Insurance mistakenly removing doctors from network and then requesting for them to complete new enrollment packages and assign new effective dates
• Insurances not extending contract participation to providers as of new year WCH takes action when times are tough and seeks fast solutions; this is how we are working around these challenging situations:
• We have enough years of experience in this industry to understand when there is a problem and we are the one telling the insurance how to fix it
• We offered professional help with processing applications to NGS Medicare, they refused to make us their contractors to help with enrollment
• We use our network connections to speed up many of the ignored requests and unprocessed applications
• We created a system of control that allows us to be on top of due dates and follow ups
• We set up educational training internally to make sure everyone is aware of the updates and issues with accounts
• We participate in training webinars providing information and sharing tips for improvement of credentialing processes
• We adapted a new way to submit applications to make the area representative’s job easier with understanding what is needed from the enrollment side
• We call area representatives daily for updates because there is no choice anymore
• We have been filling complaint with insurance management
• We have been filling complaint with the Department of Financial services (2 recent big complaints that we filed worked in our favor, which resulted in getting our clients contracts)
We, at WCH, need to stop the madness and bring back credentialing departments to efficiency. We cannot afford to have closed or unprocessed applications, wrong effective dates or anything of the kind. We fight for our clients to ensure they get what they need, we get providers on networks they need, even when it’s difficult. We need to call for help now, and take action to make sure credentialing is done right. We ask YOU, dear providers, to join us in a fight for the future of credentialing. Bring your requests to us and we will show you a way to make it happen.



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