It's a common misconception to believe that being a part of an insurance company's network automatically includes all the plans that the company offers. Let's delve into this misunderstanding by taking the example of Anthem Blue Cross Blue Shield and National Health Plan. We'll explore why participating providers need to understand the intricacies of plan participation and how it can impact your medical practice.
Anthem Blue Cross Blue Shield, like many other insurance companies, offers a wide range of subplans. While you may be a certified provider for the main network, it doesn't automatically mean that you are included in their extensive list of subplans. It's crucial to recognize that every plan is unique, and providers need to be credentialed for each one separately.
When you credential with an insurance company, it's imperative to receive a surtrust report outlining all the plans associated with your agreement. Many insurance companies provide these reports, and it's highly recommended to obtain access to them. These reports help you determine which networks and plans you participate in and which ones you do not. This information becomes invaluable for your front desk staff when verifying patient eligibility and processing claims.
Particularly for large national plans, understanding your plan participation can significantly impact your reimbursement. If a plan is not part of your contract, patient claims submitted under that plan will likely be denied. It can result in lost revenue for your practice. To maintain financial stability and the smooth operation of your practice, it's crucial to stay on top of all denials and review participation on a plan-by-plan basis.
Navigating the complexities of insurance plan participation can be challenging. However, you don't have to face this task alone. WCH is here to help. We specialize in understanding the intricacies of plan participation for your tax ID and can provide valuable guidance to ensure that you are credentialed with the plans you need to serve your patients effectively.
Being a participating provider with an insurance company is just the first step in a complex network of plans. Understanding the unique requirements of each plan and staying on top of your participation is crucial for the financial health of your medical practice. Accessing surtrust reports and reviewing participation in the plan is vital. Partnering with experts like WCH can make this process smoother and more effective, ultimately ensuring that you provide the best care for your patients.
