EPISODE SUMMARY
In this episode of The Claim Game, Jeremy and Kathryn Zug tackle the often-dreaded "credentialing black hole" – that period of frustrating silence after submitting your insurance applications. They equip you with a game-changing strategy to transform passive waiting into an active, strategic process. This episode zooms in on Stage 3 of the credentialing process: application follow-up. Learn how to set up a "mission log" to track every application, key information to record, and the optimal timing and essential questions for follow-ups to conquer uncertainty and prevent revenue-killing delays. Jeremy and Kathryn pull back the curtain on common updates you'll receive, what to do if an application is denied, and the importance of documenting everything. They share a powerful success story of a Michigan group practice that turned credentialing into a competitive advantage through proactive follow-up and robust systems. The episode emphasizes that escaping the credentialing abyss is entirely possible with a plan, consistent effort, and the right tools.
KEYWORDS
Credentialing, Insurance Billing, Revenue Cycle Management, RCM, Practice Management, Denials, Follow-up, Healthcare Business, Private Practice, Billing Process, Credentialing Follow-up Log, Practice Solutions, The Claim Game, CAQH, Payer Portal, EHR, NPI, EOB, Contract Finalization, Start Date Establishment, Practice Growth
TAKEAWAYS
The Waiting Game is Active: Don't passively wait after submitting credentialing applications. Proactive follow-up is crucial to prevent delays and lost revenue.
Create a "Mission Log": Implement a system to meticulously track every credentialing application, including insurance company, provider name, status, submission date, employee, notes, and crucially, the next follow-up date. Practice Solutions offers a dedicated log in the Hourglass Learning Hub.
Initial Check-in is Key: Call 3-5 business days after submission, even if submitted online, to confirm receipt and processing with a human. Document this confirmation and any reference numbers.
Ask Two Essential Questions: During your initial check-in, always ask: 1) How long do they anticipate processing will take? 2) How and how soon will you be notified if there's an issue or denial? Log these answers to guide your future follow-ups.
Establish a Proactive Cadence: If notification processes are slow, follow up every two weeks after the initial confirmation to consistently monitor status and promptly resolve any issues.
Document Everything (Notes are Your Best Friend): Jot down call reference numbers, specific instructions, denial reasons, and contact information. This information is invaluable for preventing future pitfalls and building your "cheat code".
Don't Give Up on Denials: If an application is denied, update your log and be prepared to resubmit. Crucially, speak to a person to get every detail about why it was denied to learn from the experience and prevent future issues.
Tools Make the Difference: Utilize resources like a credentialing document checklist, an insurance contact reference list (your "ultimate cheat sheet"), and a credentialing matrix to stay organized and efficient.
Consistency and Strategy Lead to Success: Rolling the follow-up dice isn't about luck; it's about strategy, consistency, and having the right tools to empower your practice and ensure revenue makes it into your bank account.
CHAPTERS
00:00 Introduction to Credentialing: Application Follow-up
03:33 Start your Credentialing Application Follow-up Log
05:19 Determine Your Follow-up Cadence
06:44 Confirm Receipt of Your Application + Ask Important Questions
09:36 Recommended Follow-up Cadence
11:06 Milestone Updates to Look Out For During Follow-up
13:22 What if my Application Gets Denied?
15:02 Follow-up Recommendation Once You Receive Approval
17:13 The Tools Needed to Make This Process Smooth
19:58 Case Study Card: Practice with Butter Smooth Credentialing
23:51 Conclusion: Stage 3 of Credentialing
RESOURCES
Learn More About The Claim Game: Visit practicesol.com/theclaimgame
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitingThe Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management atPractice Solutions Blog.
