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How do you communicate and collaborate with payers and providers during credentialing and contracting?

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Credentialing and contracting are essential processes for any practice that wants to participate in payer networks and receive reimbursement for services. However, they can also be complex, time-consuming, and frustrating, especially if you lack clear communication and collaboration with payers and providers. In this article, you will learn some tips and best practices to improve your credentialing and contracting experience and outcomes.

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1 Understand the requirements

Before you start credentialing and contracting, you need to understand the requirements and expectations of each payer and provider you want to work with. Different payers and providers may have different criteria, standards, and documentation for credentialing and contracting, as well as different timelines, processes, and contact points. You should research and review the requirements of each payer and provider carefully, and prepare all the necessary information and materials in advance. You should also check if there are any changes or updates to the requirements periodically, and make sure you comply with them.

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2 Establish a contact person

One of the most important aspects of communication and collaboration with payers and providers is to establish a contact person who can help you with credentialing and contracting issues. A contact person is someone who can answer your questions, provide guidance, resolve problems, and expedite the process. You should identify and reach out to a contact person for each payer and provider you want to credential and contract with, and maintain a regular and respectful communication with them. You should also keep a record of your communication with the contact person, including their name, phone number, email address, and any relevant information or feedback.

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3 Follow up and track progress

Credentialing and contracting can take several weeks or months to complete, depending on the payer and provider. During this time, you should follow up and track the progress of your credentialing and contracting applications, and make sure they are not delayed or rejected. You should communicate with your contact person regularly, and ask for updates, confirmations, or clarifications. You should also monitor the status of your applications online, if possible, and check for any errors, discrepancies, or missing information. If you encounter any issues or challenges, you should address them promptly and professionally, and seek assistance from your contact person or other resources.

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4 Negotiate the terms

Credentialing and contracting are not only about verifying your qualifications and eligibility, but also about negotiating the terms and conditions of your participation in payer networks. These terms and conditions include the reimbursement rates, fee schedules, payment policies, quality measures, performance incentives, and other aspects that affect your practice's revenue and performance. You should negotiate the terms and conditions of your credentialing and contracting agreements with payers and providers, and try to achieve the best possible outcomes for your practice. You should also review and understand the terms and conditions carefully, and make sure they are fair, accurate, and consistent.

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Brett Buckingham

Delivering Smarter Payer Contracts to Healthcare Providers
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Negotiating your payer contracts effectively is crucial for fair reimbursement. In our experiences at Aroris, persistence and preparation are key. It is helpful to provide metrics on cost, quality, and access to care to demonstrate your practice's value. Focus negotiations on the procedures that will have the biggest impact to your revenue. Before signing any new agreements, have a legal expert review any contract language to ensure the terms are fair. Negotiating payer contracts is complex, but it's a critical aspect of managing the revenue cycle effectively. Ignoring or neglecting this aspect will result in missed revenue opportunities.

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5 Update and renew

Credentialing and contracting are not one-time events, but ongoing processes that require constant updating and renewing. You should keep your credentialing and contracting information and documents up to date, and report any changes or updates to payers and providers as soon as possible. You should also renew your credentialing and contracting agreements periodically, and check for any changes or updates to the requirements, terms, and conditions. You should also evaluate your credentialing and contracting performance and outcomes regularly, and identify any areas for improvement or optimization.

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6 Use technology and tools

Technology and tools can simplify and streamline credentialing and contracting processes, reducing errors, delays, and costs. Examples of such technology and tools include credentialing software that can help manage data and documents, as well as generate reports and alerts; contracting software to create, review, negotiate, sign, and store agreements electronically; CAQH ProView, a universal online platform to create a single credentialing profile; and payer websites with information on credentialing and contracting requirements.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Sachit Verma, MD, MBA, FACHE, FAPCR
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Quality and Risk Evaluation Factors for Engagement - QM projects and program with a structured working group with representation from revenue cycle, coding, population health, care providers will help improve quality and member outcomes. Monitoring and reporting of the data, auto-enrollment and provider accessibility, transparency in maintaining the accuracy of source date will help streamline the process and identify deficiencies for compliance reasons.

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How do you communicate and collaborate with payers and providers during credentialing and contracting?

1

2

3

4

5

6

7

1 Understand the requirements

2 Establish a contact person

3 Follow up and track progress

4 Negotiate the terms

5 Update and renew

6 Use technology and tools

7 Here’s what else to consider

Practice Management

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How do you communicate and collaborate with payers and providers during credentialing and contracting?

1

2

3

4

5

6

7

1 Understand the requirements

2 Establish a contact person

3 Follow up and track progress

4 Negotiate the terms

5 Update and renew

6 Use technology and tools

7 Here’s what else to consider

Practice Management

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