Updated: Aug 22
Provider credentialing and enrollment is a process of attestation to validate that a healthcare provider is authorized to offer healthcare services. This is carried out by reviewing and verifying the provider’s license, education, experience, certifications, training, and many more documents.
Accurate and timely credentialing is extremely vital to protect your optometry practice from financial losses. In the case that you are not properly credentialed or enrolled, insurance payers may deny reimbursements for the services you have offered. Here are 4 simple steps that you can follow in order to ensure a seamless provider credentialing and enrollment process.
1. Make a Detailed List of All Prerequisites
Research and make a list of the things essential for provider credentialing and enrollment. Gather all information associated with professional licenses, certifications, references, practice ownership details, background checks, etc. Each insurance company may have its own unique process. Hence, it is essential to also make a list of the insurance companies you want to be credentialed with and collect all necessary details.
2. Obtain the National Provider Identifier
The National Provider Identifier (NPI) is a unique, government-issued identification number for covered healthcare providers. Getting an NPI is imperative before submitting claims for reimbursements or conducting any other transactions as specified by HIPAA. NPI is a single provider identification number that will be accepted by all health plans. Applying for an NPI is a simple procedure that can be carried out either online or even by mailing a physical application.
3. Register With the Council for Affordable Quality Healthcare
A significant aspect of provider enrollment and credentialing for optometry practice is getting registered with the Council for Affordable Quality Healthcare (CAQH). CAQH is a huge repository containing vital provider information including credentialing data. With CAQH registration, providers can easily submit their information to multiple insurance companies. Along with improving efficiency, CAQH also reduces the number of redundant applications or paperwork to streamline the entire provider credentialing process.
Important functions that need to be taken care of:
- Ensure that CAQH has a valid W-9 and malpractice certificate for providers
- Dates of employment and education of providers are in the ‘Month/Year’ format
- Make sure that there are no gaps in your employment history
- Reply to the quarterly re-attestation emails by CAQH in the specified timelines
4. Submit Applications and Regularly Follow Up With Insurance Companies
After registering with CAQH, optometry providers now need to start applying to the insurance companies of their choice. Carefully fill out and review your applications before submitting them to the insurance companies. Post applying, you need to keep on following up with insurance payers constantly. Regularly checking up on the status of your optometry credentialing applications helps you find out if there is anything missing from your applications. This way, you can rest assured that the applications you have submitted are accurate and error-free.
Although these steps are simple, provider credentialing and enrollment is a time-consuming and redundant process. With no prior experience, handling these procedures can be quite burdensome and challenging for optometry providers. Hence, it makes more sense for subject matter experts to deal with it while you focus on your core task of patient care.
CS Eye can streamline your provider credentialing and enrollment efforts by diligently following up with concerned authorities until your application is approved. Contact us to know more about how we can help you in your credentialing journey. Cash in on our expertise to optimize your provider credentialing and enrollment processes.