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.