Payer Enrollment for New Practices: Selecting Insurance Carriers

Starting up a new health care practice takes time and perseverance to complete the hundreds of tasks with which you are faced.

Just like a retail store must be able to accept credit cards and other forms of payment, you must be ready on Day #1 to accept insurance coverages as well as Medicare and Medicaid so those claims will be paid.

Basically, insurance carriers and applicable federal and state plans must acknowledge your practice as an in-network or participating provider. You want to be able to bill them and receive timely payment at an agreed-upon rate.

With Which Insurance Carriers Should We Participate?

The answer to this question of course is uniquely dependent on several factors including your practice location and specialty. First, you may want to enroll with large, national firms including Aetna, Blue Cross Blue Shield, Cigna, Humana and United Health Care.

You may want to consider applying to government programs like Medicare, Tricare or your state Medicaid program as they may benefit you and your patients, but participation is not required.

This is really the first step to deciding the plans you may want. It will help you to decide on the national plans you listed above. Next, identify any regional companies that may have a significant presence in your area:

• Check with large employers to see what networks they use for their employee benefits.
• Network with the business managers of your peer practices in the area to identify local payors. Go to the practices that will be referring patients to you to see what carriers they take or go on local websites to find their list.
• Ask the billing managers at hospitals with which you have privileges for payor identities.

Remember also that payer enrollment is fluid and changes with time. For example, investigate your enrollment with a payer if its claims are not being paid.

Get your practice off to a good start and begin a positive cash flow by enrolling right away with the right providers for your practice and your geographic area.

Be sure to look for our next blog on “Payor Enrollment for New Practices: When To Start the Enrollment Process.”

Let Us Manage All Your Payor Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.