provider credentialing services

Complexities with closed panels are to be settled on a “case-by-case” basis. Over the years, we have learned to navigate difficult cases such as closed panels. It is true that with thousands of new medical professionals graduating every year, there is not enough space at insurance to credential everyone. Clients that hire the WCH team to handle such cases are assured that our credentialing specialists will use all available resources: contacts, evaluation of practice location region, database of participating providers in the area and apply our knowledge and expertise to help our clients get into closed panels.

WCH can complete the credentialing process for new providers within 90 days, for established providers that are making any changes within 60 days, for facility enrollment up to 180 days.

It depends on the patients’ insurance plans and benefits. Each patient has a specific health plan coverage that delegates the reimbursement and eligibility requirements. Nevertheless, the provider is financially responsible for seeing the patient before checking patient benefits and insurance credentialing requirements. From our experience, we can say that the majority of insurance companies prefer to pay contracted providers. Talk to us before making your decision. We can help to create a timeline and structure that will give you the possibility to get payments for your work.

Yes, you will have assigned a credentialing specialist that will be the primary person for communication between you and the insurance company. You will be able to speak with the Credentialing Department Supervisor and Manager.

We do not stop even there is a rejection of an appeal or new enrollment. Our job is to get our client enrolled with insurance. Several steps that can be done to request reconsideration or second-level review. We have the experience to handle rejected cases in enrollment and second level appeals to help our clients to become accepted by the insurance.

No, submitting an application to the insurance does not provide a guarantee that insurance will accept providers into the network. Before submitting the application, it is crucial to find out if the panel is open for the provider specialty. Once the confirmation has been received, the provider can submit an application.

Our experience has shown that direct contracts are the best option for providers. However, considering the closure of plans for certain specialties, the amount of time it takes to complete one application to join insurance, IPA sometimes can work better for practice. However, we consult our clients always to go directly. IPA should be a last resort for healthcare providers.

Yes, all pending cases or any type of open/closed case must be disclosed to the insurance company during the credentialing process. CAQH must also reflect your most updated information. Supporting documents for each must be attached to demonstrate the details.