A Brief Guide For Contracting With Insurance Companies

Chatting with Bradley Bigford, NP & Founder of Table Rock Medicine opened my eyes to a world of medical professionals that are passionate about providing individuals with excellent care no matter their financial situation. In fact, Bradley often serves homeless populations and does everything he can to provide his clients with discounts needed for excellent care. 

One way Bradley makes healthcare accessible for his patients is through accepting insurance coverage. That way, his patients get the care they need with costs covered, and Brad can still get paid a reasonable rate for his services. 

If you’ve recently started your own mobile healthcare business or telehealth practice, then you may want to consider contracting with insurance companies to increase your range of healthcare coverage. 

If you’re a baby entrepreneur, and you’ve just started your practice, then the thought of contracting with insurance providers may seem overwhelming. I assure you, it’s easier than you think! 

Here’s a step-by-step guide for contracting with insurance companies: 

  • Step 1: Figure out good candidates for third-party payers. 

A simple survey of your patient populations can help you determine which third-parties are most used. Be sure to conduct large surveys that offer you accurate data to make educated choices when deciding to partner with insurance providers. 

  • Step 2: Gather needed information about contracting with different insurance companies.

Now that you have a good idea of which insurance companies could be good to partner with, you need to collect information. The best way to strike up a dialogue about contracting with said insurance provider is by chatting with other professionals who have current relationships. You can also gather intel by calling an insurance company’s Provider Line. 

  • Step 3: Make contact with the insurance provider. 

A big step in the right direction is to make contact with the insurance provider. This may include asking for an initial application, and in some cases insurance providers require a letter from your practice before giving out applications. 

  • Step 4: Obtain an NPI number for your business. 

This is perhaps the most important part of the process. Without a National Provider Identifier number you can’t work with insurance providers. This is a unique process of its own which you can read more about here: https://nppes.cms.hhs.gov/#/ 

  • Step 5: Have your clinicians register with the Council for Affordable Quality Healthcare’s (CAQH) – Universal Provider Datasource (UPD). 

This step allows healthcare providers to index information about credentialing including updates and access to information.  Remember to keep this information handy when completing your application! 

  • Step 6: Complete the application! 

Once you’ve completed step 1-5 you’re ready to complete your application. It’s always a good idea to keep copies of your application and stay up-to-date on the status of your application with the insurance provider. 

  • Step 7: Review terms and rates. 

It’s crucial that you have a clear definition of your costs of services before signing off on a contract. This includes non-covered services that should be added to your financial analysis. It may also be beneficial to have a legal representative take a look at your contract and ensure that you can fulfill the terms of service. 

  • Step 8: Time to negotiate. 

Just like any other legal contract, don’t be afraid to negotiate certain conditions. It’s always a good idea to specifically read over paragraphs that discuss covered services and fee schedules, as third-party payers often use terminology that can be confusing or unclear.

  • Step 9: If you agree to terms, fees, and conditions, sign the contract! 

This step is easy! Simply sign the contract and start benefiting from third-party payers that help you and your clients. 

  • Step 10: Keep your contract on file. 

It’s smart to keep contracts readily available, so you can stay on top of updates and renewals. 

To listen to my podcast episode with Brad – Click here

For more tips and tricks for NursePreneurs be sure to subscribe to my YouTube channel or visit my Facebook NursePreneurs.

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