Learning & Resources for Organizations

Being in-network with an insurance company doesn't mean you're in-network with every plan they offer. This is something I wish more practice owners and patients understood. Insurance companies often offer multiple networks under the same payer. Some are broad networks, while others are limited or restricted, including certain HMO, employer-specific, and narrow-network plans. And here's where it gets complicated: Not every network is available for providers to join, and insure

Adding a provider to your practice usually means you're growing. But before you give them a start date and start putting patients on their schedule, there are several things you need to have in place. Your provider needs to know what is expected of them, what they are responsible for, what the practice is responsible for, and who handles what. That starts with a solid onboarding process. Here’s what you need to have in place before your next provider starts. Start with the lo

One of the biggest misconceptions I see is that once you're approved with an insurance company, you can immediately start billing. That's not always the case. This only applies to new contracts and newly credentialed providers. For new contracts, most insurance companies have a separate loading process that happens after your credentialing has been approved. During this process, they add your information to their claims system, including your NPI, Tax ID, practice informatio

The first question I ask clients is do they want to have the flexibility to add/credential another provider with their practice at any point in the future. This guides us to determine what the next steps are and how they should credential their practice. If the answer is yes, then we need to make sure they have a group NPI. The group NPI When you credential with the insurance payers, you can enter into a contract using your Individual NPI (type 1): Individual/solo agreement O

If you're credentialed with insurance companies, you've probably started seeing references to DataSpring. That's because CAQH has officially rebranded. The good news: from a provider perspective, nothing is changing operationally. DataSpring is still the platform insurance companies use to obtain provider information for credentialing, enrollment, provider directories, and other administrative functions. Your login, profile, attestation process, and workflows remain the same.

Keeping your demographic information up to date with the insurance payers is important. If something changes (you change physical office locations, etc.) you need to update that information with the insurance payer. If you do not, this could impact reimbursement for services. I have included the links, forms, and instructions below for completing demographic updates with the major insurance payers in Kentucky.