Getting credentialed (or getting Providers on board with Insurance) involves retrieving and filling out a series of applications with insurance companies, submitting the applications to insurance companies, ensuring each has been received by Insurance and eventually doing follow-ups to track the progress of each application.
While it seems like there are only a few steps, which sound simple enough to complete, health providers often describe the process to be “nightmarish” as the application process rarely goes smoothly, and many providers find themselves resubmitting applications, fighting enrolment rejections, and spending a whole lot of time “on hold” with insurance companies. Additionally, many of the panels that you apply to may say that they are full or are not accepting people with your specialty at this time.
Pinnacle RCM works on the insurance companies that Provider wants to be credentialed with. Every Insurance Company requires a different process with varying hoops you have to jump through. We retrieve applications, fill out the same, organize necessary documentations and follow up with Insurance- While some applications are electronic the vast majority needs to be printed and completed manually. Insurance companies generally lose track of Provider applications, or put them in “limbo” and the medical credentialing process goes nowhere. Hence we ensure timely follow ups so that the application doesn’t get stuck or expire due to automatic rejections- leaving with no option but to start again.
In a nutshell every time an application is faxed, emailed or mailed- we do a consistent follow up for the updated status from Insurance.