How to Get In-Network with Insurance Companies


Many insurance companies actively try to recruit new physicians to their plans others try to limit the number because they believe having more providers will lead to “over-utilization”.

The question is, how do you get on with these companies in the first place?

The acclaimed In-Network Provider

So you want to be in network with XYZ Insurance company?

It is actually easier than you might think for most commericial insurance companies.  Lets begin

  • You will need your license
  • your malpractice insurance cover sheet
  • your type 1(Providers) and type 2(businesses) NPI numbers(Register Here, takes a few minutes)
  • your EIN
  • your SSN
  • practice address
  • specialty code(you can look it up)
  • educational history
  • job histories
  • paperwork for any convictions such as felonies, misdemeanors, or actions taken against your license in any state
  • an “in” with CAQH

CAQH?

Yeah, they will be a central source for all of the data above, but you need a number for their database to get in and register.  Once you are registered all of the insurance companies will turn to this database for the information they require.

Cigna gave us this “in” in Florida.

Medicare

How to get "in-network" with insurance plans

Photo used under Creative Commons from hanspoldoja

Medicare does not use CAQH as a data source.  They have their own website for applications called PECOS.  Through school I heard many nightmares about this application process, but I had no problems whatsoever.

With Medicare you can choose to be Participating or Non-participating.  Some Chiropractors think they are sticking it to the man by being Non-participating, but if you do the math you are actually saving the government money and charging the patient more money by going up to the limiting charge.

In both situations you have to submit the paperwork and claim to Medicare, otherwise you are technically breaking the law.

Also, if you see a patient a just charge them the Medicare fee you are technically breaking the law.  Also if you don’t charge them the exam fee which Medicare will not pay for you are breaking the law!  Aigh!

Find the Insurance companies you want to be In-network with . . .

The process is simple once you are in CAQH.  You find the company you want to be in network with, say Florida Blue, Humana, Aetna, Cigna, United HealthCare, etc and you browse their website for the “Providers” section.  Somewhere you will find a “Join our Network” page that has instructions on how to join.

The instructions for each company are different and the responses will range from a few days, to months, to I’m going to call.  Some companies have a web submission, some have paperwork to fax, and some have you call and talk with a person.

Conclusion

Eventually you will hear back from the company with either a no or a “sign here”.  Review the contract and ensure you can be compliant with it and that there is a way out for you.  Also have you team look it over(lawyer).  Some companies had me signing a contract online within 2 weeks and other took 8 months from start to finish to be in network.  Still other insurance companies said no.

We are still trying to be part of the Florida Blue Network.  It is frustrating that an honest, ethical doctor can’t be part of a plan when there are so many that are on the plan that only have money on their minds with 60 visit care plans that exhaust insurance benefits.  There is no money in a cure . . .

How many insurance networks are you “in-network” with?

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