There are intricate processes in place that allow healthcare providers for behavioral health practices to become credentialed with health insurance providers. The process of getting credentialed can open up the door to more patients and increase revenue. In this blog, we’ll dive into how to get in-network with Blue Cross Blue Shield (BCBS) and other health insurance providers.
BCBS In-Network Providers
Anthem Blue Cross Blue Shield is a diverse network that works with a range of healthcare professionals. If you are starting or have started a healthcare business and you want to work with them, you need to get approval as an in-network provider. In-network providers are those approved by BCBS. When patients request treatment, they can only use their healthcare benefits for those facilities that are approved.
BCBS has online resources to help you understand important parts of the process, such as:
- Prior authorizations
- Referrals
- Claims and payment processes
All of these resources are streamlined to coordinate better care for innovative patient education. Those businesses who are approved to work in-network will have access to online self-service tools, case management resources, and local provider relations staff who can support your business.
Establishing Credentials
Becoming an in-network provider with BCBS starts with the credentialing process. For this, you’ll have to establish your legitimacy within relevant fields. This requires that you be a fully licensed clinician and that you undergo credentialing with the insurance company as well as any relevant government agencies.
This establishes the legitimacy of each practitioner who works with your business, whether you offer psychological services or other mental health services. Near the end of this process, you’ll start negotiating a fee schedule and any relevant terms for your contract.
This process can take upwards of six months, so it’s something that you should consider starting early, especially if you have a new business or you are opening your own practice in the near future.
How To Get In-Network With BCBS
If you have a healthcare business and are not currently contracted with BCBS, you have the opportunity to apply and join by submitting the Provider Enrollment request form. This starts with filling out your state and the type of business you run.
Once you fill out the request form, a Provider Relations representative will contact you with the following steps. For ancillary providers, they don’t have instructions yet online but you can contact their help line.
Those who have businesses in applied behavior analysis (ABA) with credentials that include treating autism spectrum disorder have separate credentials through Provider Relations with BCBS.
That said, the application process can be complicated and lengthy. There can be a lot of back and forth with Provider Relations.
Getting Professional Consultations
It can be difficult to get your group or practice contracted or approved by BCBS, but with the help of professional consultations, your process to join a provider network may become much easier. Professional healthcare startup planning with C4 Consulting can give you the tools you need to better understand the requirements of the request form and to address any of the next steps you encounter when working with Provider Relations.
Credentials: Why Use Professional Consultations
It is possible to establish your credentials yourself, but this will require focused work, and negotiations about your fee schedule can be difficult on your own, especially if you are just starting your healthcare business.
Once you have established your credentials, you will need to re-credential every two years, and with that, you need to keep track of elements such as:
- Proof of insurance
- References
- NPI number
- Medical license
- CAQH number
- EIN
- DEA number
Working with professional consultations can help you avoid snags with your application and make sure that you can maintain the files you need for re-credentialing processes. If you are new and unsure of what is involved in negotiating your fee schedule and contract, a professional consultation can answer questions here, too.
Contracts: Why Use Professional Consultations
As you negotiate through the application process, one of the final steps will be to create your fee schedules and contracts. This is a breakdown of what the insurance company, in this case BCBS, will reimburse you for your services.
There are no guaranteed rates but rather differences based on the license you have, your location, what BCBS is willing to pay, and your CPT code. With professional services, you can learn the importance of renegotiating your contract rate annually based on your specialization, location, license, and education.
Overall, getting in-network with BCBS can be a challenging and time-consuming process. With the help of professional services like C4 Consulting, you may find that many parts of the process go smoother. Our extensive range of behavioral healthcare consulting services includes insurance credentialing consulting that can help through the process of becoming an in-network provider with BCBS.
Reach out to our team today to learn more about contracting with BCBS.
