Credentialing is a very complex process. Sometimes it takes so long and goes so difficult that providers just agree on whatever Health Insurance plan offers.
Once a provider is contracted with a plan, he or she must accept plan’s fee schedule as payment in full.
So a medical center/provider that helps many people every day faces a problem with insurance reimbursement. Expenses are higher from year to year but the payment remains unchanged and now does not provide sufficient compensation for the time and resources spent.
Does it sound familiar? Why are specialists in one of the most important and noble professions unable to get a fair reimbursement for their labor?
WCH knows – they are! Despite a time and patience consuming process, any of the contracts may be negotiated. Credentialing specialist – Julia Panomareva knows exactly what to do! Here are some examples of successful renewals.
After several refusals, finally, WCH got approval from Magnacare on increased rates for an Urgent Care facility. “We did not accept the first denial as final as we do know that providers are entitled to the fair reimbursement for services being performed and we do everything so the insurance plans can hear us,” says Julia.
One more example of the successful rate increase. Right after the initial credentialing application approval, Julia requested rates negotiation with Amerigroup and received a positive result from the very first try. “I am glad to know that our clients now have suitable payment for their services!” says Julia.
“Many are in the process yet, but definitely doomed to success – Center Plan for Healthy Living, Fidelis Care, United Healthcare and other” – concludes Julia.
Once you have calculated your expenses and payments and realized that it does not cover your outlays – open the negotiations case with insurance carrier. Remember to track your other contracts and open renewals requests right away as you found it insufficient.
Don’t feel uncomfortable opening such requests, as you do the job, the very important job, you help the people and improve their lives and there is no magic, but honest labor.
So, stop losing money! ACT now! WCH is here for help!
Julia also shared one more successfully finalized case with enrollment process to a Closed Panel in Elderplan network. The enrollment was initiated in 2015, it took two years of fighting, appealing to persuade Elderplan to accept our client into the closed network. In 2017, WCH won the deal and got the client in! “When you have a goal and you know your rights as a provider – never stop! Remember to keep putting one foot in front of the other,” says Julia.
As you can see, WCH knows in practice that everything is possible and WCH is here for help!
Contact our credentialing team to get the best rates for your practice.