Credentialing & Contracting

Patients seeking medical help should not have to be burdened with questioning whether insurance companies will cover their medical expenses. Medical practices should not have to be burdened with establishing their legitimacy, however credentialing is necessary for medical providers to become part of any government or commercial payer’s network. Joining a payer’s network can be an essential tool to extending your services to patients that may otherwise not have coverage at your practice.

It is critically important that all providers are credentialed in order to establish the qualifications of its licensed medical professionals, as well as undergo assessments surrounding the practice’s background and services. Credentialing is the process of obtaining, verifying and assessing the qualifications of a medical practitioner. This ensures the practice is equipped with licensure, training, education, experience and other qualifications that legitimize the medical practice.

Without comprehensive credentialing a practice is generally not permitted to treat patients at an in-network level. When processing out-of network claims a payer may choose to only pay part of a claim, which may subject the patient to large financial responsibility in paying the amount insurance did not cover; this is called a ‘balance bill’. In addition to balance bills, most insurance policies carve out higher out-of-pocket costs for their members that seek out-of-network providers, further increasing the risk of financial hardship a patient may be left with. This can create contention between the patient and the practitioner. Here at Acme Billing Solutions, we are here to alleviate this burden for our clients by credentialing each practice so they can focus on taking care of their patients. 

Another seemingly daunting task for a medical practice is working out payer contracts with insurance companies. Insurance contracts represent a significant amount of the physician revenue and should be evaluated and negotiated with extreme precision and care. Negotiations with insurance providers are not necessarily hard to do, but they do require time and attention to detail that practitioners should instead be using to focus on offering the best possible services for their patients. Some of the aspects of negotiating insurance contracts include analyzing the contracts by reviewing the primary insurance average allowables for your top services, collecting and providing accurate internal data regarding your services, gaining a clear in-depth understanding of legal documents, and knowing your market share. 

Through Acme Billing Solutions’ implementation of the above strategies, we can provide your practice with an improved payer-provider relationship, promote patient satisfaction, and boost revenue for your practice on your terms. The goal with our healthcare credentialing services is to advocate for your business and ensure that all of the seemingly daunting tasks such as healthcare credentialing services and negotiating insurance contracts is taken care of so you can focus on what matters most – your patients.