Author Topic: Insurance enrollment charges  (Read 2851 times)

DavidZ

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Insurance enrollment charges
« on: December 21, 2009, 06:04:43 PM »
What do you charge to enroll a provider(credentialing).
Is it per payer?

Michele

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Re: Insurance enrollment charges
« Reply #1 on: December 23, 2009, 06:33:36 AM »
It is usually per payer. 
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DavidZ

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Re: Insurance enrollment charges
« Reply #2 on: December 24, 2009, 02:44:42 PM »
What is the going rate per Payer?

Happy Holidays to All and All the Best for 2010!

David

Michele

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Re: Insurance enrollment charges
« Reply #3 on: December 26, 2009, 09:21:38 PM »
It depends on if they use CAQH, we charge $40 per payor (that's if the CAQH is all done) and if they do not use CAQH, then we calculate depending on the amount of time the app will take (estimated).

Michele
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DavidZ

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Re: Insurance enrollment charges
« Reply #4 on: December 28, 2009, 03:04:17 PM »
I see

PMRNC

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Re: Insurance enrollment charges
« Reply #5 on: December 29, 2009, 08:24:37 AM »
I Bill my hourly consulting rates because usually I am negotiating contracts and fee schedules and consulting with providers attorney when necessary and for final sign off.
Linda Walker
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DavidZ

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Re: Insurance enrollment charges
« Reply #6 on: December 30, 2009, 09:51:08 AM »
I was also thinking of charging the consulting rate, was just trying to find a going rate, thanks!

Michele

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Re: Insurance enrollment charges
« Reply #7 on: December 30, 2009, 10:49:37 AM »
Consulting fees vary greatly, anywhere from $100 - $500 per hour, depending on the type of consulting, and the knowledge and experience of the consultant.

Michele
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midwifebiller

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Re: Insurance enrollment charges
« Reply #8 on: January 20, 2010, 01:06:12 PM »
I have noticed the new book out about Medicare Enrollment.  I would like to start offering credentialling services, but have a few questions for those with more experience in this area (95% of our providers are out-of-network).

Is Medicare enrollment similar to credentialling and contracting with commercial carriers or is it a completely different ball of wax?

How successful have you been in negotiating contracts?

Thanks!
~Kelli
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

Michele

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Re: Insurance enrollment charges
« Reply #9 on: January 20, 2010, 08:39:54 PM »
Medicare credentialing is completely different (in my opinion) to commercial credentialing.  I personally like it much better as to me it is straight forward, and the same all over the country.

I don't do fee negotiations, or contracting.  I keep it to the basic level of credentialing, by choice.

Michele
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kwardbilling

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Re: Insurance enrollment charges
« Reply #10 on: January 21, 2010, 09:09:37 AM »
I too have started to think about learning the procedure for credentialling, as I believe the counselors I work with would put this to use, and I also see that it could bring me in other clients.  I guess my question is similar, is this a process I can learn on my own, with the help maybe of this new book you have published Michele, or without any training would I be opening a can of worms?  I wouldn't expect to get in to the contract or fee negotiations, just applying ....any thoughts?

Michele

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Re: Insurance enrollment charges
« Reply #11 on: January 25, 2010, 06:30:06 AM »
I am not aware of any training out there for credentialing services.  I learned as I went.  That is not a good method when starting billing, but for credentialing it is different.  If you are interested in Medicare credentialing then I do think our new book would be helpful.  There is a lot of information in there about Medicare credentialing along with detailed instructions on completing several of the forms.

Good luck
Michele
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PMRNC

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Re: Insurance enrollment charges
« Reply #12 on: January 26, 2010, 12:18:32 PM »
I actually took contract law classes and obtained my paralegal.. while credentialing I worked with the providers attorney's who helped me further and were there to sign off on any contracts/negotiations. I find clients want the full service but with it comes a price tag. I still require that all my providers that have me do FULL credentialing, contract reviews and negotiations have a practice legal counsel to give a FINAL thumbs up on. Their work is done with the exception of final review and any revisions they might have to protect my provider. I have a separate contract for credentialing that contains legal disclaimers and states the practice is obligated to have a final sign off by their attorney. In my experience I have found so many doing credentialing don't find all those loop holes in provider contracts that can really put a practice in a strong hold. (long opt out waits for example)
Medicare is the easiest and like Michele said.. Straight forward, no surprises :)  But I can tell you lots of stories about the private plan contracts, those carriers will insert all kinds of crazy stipulations in their contracts hoping to slip them by.

Also I think if you are going to offer credentialing it's important to know certain things like what to do if a carrier says their panel is closed. I've seen many just accept it, tell the provider and do nothing. There are ways to get into closed networks.
Linda Walker
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www.billerswebsite.com