Many rehab therapists believe that once they are in-network with an insurance panel, they are an in-network with the insurance indefinitely. This is just one of the common misconceptions of credentialing. The truth is, group and individual providers need to complete recredentialing applications periodically to remain in-network. Let’s take a closer look at recredentialing to avoid unexpected contract termination.
What is recredentialing?
Recredentialing is the re-verification of information that insurance companies have on file for a group or individual provider. To remain a participating provider, you must attest that information on file is accurate and submit updated copies of important documents such as license or liability insurance.
How often is recredentialing required?
Most credentialing applications have yet to adopt a uniform process so each insurance company has a different timeline. For example, Medicare providers are required to recredential every 3-5 years, depending on the Medicare Administrative Contractor (MAC) assigned to your state. Optum, the therapy contract administrator for United Healthcare, requires recredentialing every three years. This makes it all the more important that your staff is aware of your credentialing effective dates.
How do I know if I’m due for recredentialing?
Insurance companies will notify providers that they are due for recredentialing months prior to their due date either by mail or email. This is why it is so important to update your email and practice address with the insurance so they are sending notices to an accurate email/address. Medicare providers can check their revalidation due date at https://data.cms.gov/revalidation.
What if I forget to recredential my practice or provider?
Many providers are unaware their enrollment has been suspended/terminated until they start to receive denied claims. Depending on the insurance, providers must resubmit an entirely new enrollment application or submit the recredentialing application to reactivate their enrollment. During this time any claims submitted will process out-of-network. If your contract was terminated, the effective date will be determined by the insurance company. We recommend contacting provider relations and determining the best process for reactivating the participation status.
We created a Recredentialing Tracking tool which can be used to track and maintain your participation with insurance panels. List all providers working in your practice so they can easily see effective dates and when recredentialing is due. Being diligent with your recredentialing is the only way to avoid unexpected termination. If your practice or providers need assistance with credentialing or recredentialing, reach out to the experts at Account Matters, Inc. at firstname.lastname@example.org or give us a call at 508-422-0233.