You finally got that shiny credentialing approval. Naturally, you might think you are officially ready to start billing insurance and getting paid.
Not quite. It is a huge misconception that credentialing automatically equals a signed contract. Right now, you are simply approved to work as a dietitian, but you are still considered an out-of-network provider. If you see patients today, they will likely owe out-of-pocket money for your services.
We know how incredibly frustrating it is to feel like you are jumping through endless administrative hoops just to do your job. Take a deep breath and grab your coffee. After helping countless dietitians navigate this maze, we know exactly how to help you cross the finish line.
Let’s talk about contracting. This is the actual, legally binding agreement between you and the insurance payer.
The Panel Problem: Open vs. Closed
When you apply to an insurance company, they will check to see if their specific provider network—or “panel”—is open or closed.
- Open Panel: The payer has a verified need for more dietitians in your specific geographic area. They will actively accept your application and offer a contract.
- Closed Panel: The payer feels they already have an adequate number of contracted dietitians to serve their members in your area. They are not accepting new providers right now.
The Workaround for Closed Panels
If you hit a closed panel, do not panic. Building up your contracts simply takes a little time.
Plus, if you serve a specific niche population, you can sometimes submit a Letter of Intent (LOI). This letter informs the payer of the high demand for your specific services and asks them to make an exception.
Here is a little industry secret we have learned over the years. Sometimes, a panel is completely closed for commercial plans, but it is wide open if you are in-network with Medicare or Medicaid.
So, before you apply to those commercial plans, think about your target audience. If you are considering the Medicare or Medicaid population, be sure to obtain those specific provider IDs before submitting your commercial contract requests. It just might be your golden ticket in.
Your 3-Step Plan to In-Network Success
Going from CAQH to a signed contract does not have to be an overwhelming ordeal. Here is your simple, three-step plan to seal the deal:
- Initiate the Application: Head over to the specific insurance company’s website. Look for the “Providers” section and click the link that says “Join Our Network” or “Become a Provider”.
- Provide Your Information: CAQH Number, Medicare/Medicaid IDs etc. Thankfully, you do not need to submit a massive stack of paperwork. In most cases, this is a quick online form. Just hand over your IDs, basic business & service location info. Pro Tip: Ensure you have checked the box in CAQH that grants any payer permission to view your data.
- Sign the Contract: The insurance plan will pull your data directly from CAQH, evaluate your qualifications, and check their panel. Once you successfully pass the review, they will offer you a contract to sign. *This can take 30-60 days with the insurance plan.
Stop Waiting, Start Billing
If you try to wing this process, you risk endless delays, closed panels, and patients who simply cannot afford out-of-network fees.
But once you sign that contract, you are officially in-network. You get to focus on helping your clients thrive, knowing your claims will actually get paid.
Stay tuned for Part 3: Coding, Billing & Claims (Getting Paid) Coming Soon
Until then, do you need help cutting through the red tape?
Schedule a Clarity Session with Laura today