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What is the Medical Credentialing Approval Process for Holistic Practices?

medical credentialing

As a holistic practice, you want to deliver the best treatments of holistic medicine to your patients - while also ensuring you are paid! To service your patients and grow your holistic business, however, you will want to consider provider credentialing as an in-network provider to bill insurance plans. To be approved, you must meet the numerous medical credentialing requirements for your practice. Besides meeting the requirements, you also must ensure that all the complicated paperwork is filled out accurately and the right documentation is gathered. 

Don’t be discouraged, however! There are ways to ensure you’re approved the first time you apply for medical credentialing. Here are some considerations to keep in mind so you have everything you need to know before starting the insurance billing credentialing process.  

What is Medical Credentialing?

The process of verifying a healthcare provider’s qualifications for administering care to patients to bill insurance providers, medical credentialing is necessary to receive reimbursements for services. Medical credentialing is a common process for most insurance billing, including many commercial insurance companies, medical groups, surgery centers, or government plans like Veterans Affairs, Medicare, and Medicaid. 

Generally, the medical credentialing process involves various applications, forms, and documentation, though the exact requirements vary on the insurance provider. Typically, the provider credentialing process must verify that the medical practice’s documents are current and valid. This can include medical licenses, malpractice insurance, DEA, board certifications, and any other additional information necessary to complete the credentialing process.   

What are the Common Challenges in the Medical Credentialing Approval Processs?

Although the medical credentialing process is essential to receive reimbursements, there are many potential issues - and ensuing consequences - that can occur. Since provider credentialing is integral to generate revenue, it’s one of the most important processes for a holistic practice. However, data errors, accidental omissions, or any other hiccups in the process can result in incomplete credentialing and possible financial complications. 

Medical practices - holistic or not - lose revenue and waste valuable time and money with common medical credentialing mistakes. So, being aware of the common challenges in the medical credentialing approval process can help avoid these costly errors!

Incomplete Applications

A common mistake that plagues medical practices, sending incomplete provider enrollment applications can set back the provider credentialing process for weeks, if not months. The general application for credentialing requires an extensive amount of paperwork and documentation - all that needs to be filled out correctly. Failure to complete the provider credentialing application accurately can result in lengthy reimbursement delays and denied claims that can negatively impact your bottom line. 

While some mistakes are inevitable, ensuring qualified credentialing helps eliminate the margin for human error, saving your holistic practice time and money. 

Lack of Organization

An organized practice can lead to inaccurate provider credentialing applications, lost paperwork, or extra time spent on the entire process as a whole. Having all your important paperwork and data where it should be and gathered will avoid any issues in the future, such as claim denials or inaccurate physician contact information. 

Proper organization can also make the entire medical credentialing process as efficient as possible, so your holistic practice can focus on the day-to-day operations of delivering services to patients and receiving payments. 

Not Updating Information

Even after healthcare providers are credentialed, all provider contact information needs to be kept up to date. Depending on the state in which you practice, licenses and credentials need to be renewed regularly. During the re-credentialing process, having up to date information on every individual practicing, including licenses and contact information, will be important for an efficient and accurate process for your holistic practice. 

Besides making the process exponentially easier, keeping up to date with physician licenses will also help avoid potential bad patient outcomes if a physician is practicing without an updated license. 

Medical Credentialing Checklist for Holistic Practices

To avoid possible claims denials and lengthy issues, you want to make sure your provider credentialing is as accurate the first time around as possible. Since the medical credentialing process can be lengthy and full of complicated documentation, a checklist can help ensure no important data is missing. 

Here are some medical credentialing checklists for holistic practices to help provide an accurate and speedy credentialing outcome! Remember that, depending on the state in which you practice, you may have additional medical credentialing requirements that are not fully covered by the process. 

Massage Therapy Credentialing

massage therapy

  • Know your state requirements for holistic practices
  • Provide your NPI (National Provider Identification)
  • List all relevant professional licenses
  • Provide any evidence of education or training
  • Include all board certifications
  • Include DEA certifications
  • Malpractice Insurance, if applicable
  • Current Competence to Practice certifications

Chiropractic Credentialing

chiropractic treatment

  • Know your state requirements for chiropractic holistic practices 
  • Get your NPI (National Provider Identification)
  • Licensure: All practitioners must have and maintain a current, unrevoked, unsuspended, and unimpaired license to practice chiropractic in the state where their holistic practice is
  • List education or training
  • Practitioners must also complete and maintain all continuing education hours as required
  • If your practice performs X-rays, make sure to follow radiographic guidelines and x-ray criteria
  • Include all board certifications
  • Include DEA certifications
  • Malpractice Insurance, if applicable
  • Current Competence to Practice certifications

Acupuncture Credentialing

acupuncture treatment

These are essentially the basics for acupuncture credentialing in most states in the District of Columbia. 

  • Graduated from an academic program with U.S. Department of Education recognized accrediting agency
  • Passed relevant licensing or certification examinations, or is nationally board certified by the NCCAOM®
  • Holds a license in the appropriate jurisdiction
  • Education or training
  • Include all board certifications
  • Include DEA certifications
  • Malpractice Insurance, if applicable
  • Current Competence to Practice 

Turn to Holistic Billing Service's Medical Credentialing Services to Get Approved for a Network the First Time Around!

Medical credentialing for holistic practices can be a lengthy and complicated process, but one that is an option to receive reimbursements from insurance companies as an in-network provider. An efficient and accurate provider credentialing service is essential for a healthy bottom line, but the process can be full of complicated paperwork that needs to be filled out precisely. By outsourcing your medical credentialing to professionals, you can trust that your credentialing is filled out correctly - the first time around!

At Holistic Billing Services, you can trust our team of experienced billing and coding experts to understand the unique needs of holistic practices and can help you take steps to accelerate your revenue cycle management and avoid claim denials. Since we deal exclusively with holistic healthcare practices like acupuncture, massage therapy, and chiropractic treatments, we are familiar with the medical credentialing approval process and how it affects your business. For any questions about holistic billing, feel free to contact our team today, and let us know how we can help your holistic practice!

December 28, 2020
 - by Antonio Arias, MBA, CHBME
medical credentialing
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