Q. What is credentialing?

A. It is a process by which insurance carriers and hospitals verify the credentials of the medical provider. This includes verification of licenses, verification of malpractice insurance, verification of college degrees and background checks to disclose any felonies or criminal activity.

Q. Why is credentialing important? Who is it important to?

A. It is important to the provider to maintain his credibility with the insurance carriers and to hopefully receive a contract to participate in an insurance companies various programs. This is critical to a medical provider due to the fact that most of us want to see a doctor in our network as it creates a savings for us with our medical expenses. Most out of network benefits require us, the patient, to meet a deductible before any payments to the provider of services are made.

Q. How does credentialing help the medical provider?

A. Once a medical provider is credentialed and accepted into an insurance plan, their information is then posted in the provider directory. If a patient is looking for a medical provider in their network, they usually search by zip code. If a medical provider is not listed in that directory, the medical provider has missed the opportunity to get a new patient. Therefore, credentialing in a sense is a marketing tool as well.

Q. How does a medical provider go about the process of credentialing?

A. Credentialing is an extremely time consuming process and requires an individuals’ undivided attention. Current documents must be attached to a standard application which should be type written for legibility. Documents include licenses, diplomas, resumes, and declaration pages of the current malpractice. A cover letter should accompany the application and documents, introducing the provider to the carrier or hospital. Most providers use an outside service for this process.

Q. How long does it take to be credentialed?

A. Most carriers take from 90-180 days to complete their credentialing process. Once the provider is credentialed, the applications goes before a committee for final acceptance into an insurance plan.

Q. How will the provider know if they are accepted into a plan?

A. Most carriers inform the provider via letter along with a welcome packet of some type. Another method is to track your application which requires someone to contact the carrier every couple of weeks to check the status of the application.

All in all, credentialing is a very important part of the medical providers’ business.

Michele Graham
CEO and Owner of Professional Healthcare Management
Billing and Credentialing Service
41 years in the healthcare industry

http://www.phmnetwork.com
http://phmnetwork.blogspot.com

http://www.healthcarenewsonline.com

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It’s a fairly common practice, claiming compensation from the another driver’s insurance company in the event of a road traffic incident. However, if the driver whom you had the accident with had left the scene and subsequently cannot be trace - then what? Also, what can you do if the other driver doesn’t have insurance?

Well thankfully, you may still be able to make a claim compensation from the UK Motor Insurers Bureau.

Claims going through the UK Motor Insurers Bureau is similar to making a normal claim. Your case will be reviewed by the ruling judge and a decision is then made in regards to liability and how much compensation you should be awarded which will be paid by the UK Motor Insurers Bureau.

MIB was established in 1946 as a private company limited by guarantee for the purpose of entering into Agreements with the Government to compensate the victims of negligent uninsured and untraced motorists. Every insurer underwriting compulsory motor insurance is obliged, by virtue of the Road Traffic Act 1988, to be a member of MIB and to contribute to its funding

The MIB can give compensation to someone who is involved in a motor accident caused by an uninsured driver or untraced driver. If the driver was uninsured, the MIB can pay compensation for personal injury or death and/or damage to property. If the driver has not been traced, the MIB will consider claims for damage to personal property providing the vehicle can be identified.

Normally, the UK Motor Insurers Bureau will make a payment for both your vehicle and any personal injury suffered by yourself. This may also cover loss of earnings and medical expenses, pain, distress and suffering - all covered by the UK Motor Insurers Bureau

***************************************************************

If you need advice or would just like to speak to someone, please don’t hesitate to give Claims Master Group a call on 08000 71 22 71.

The Personal Injury, Accident Claim, No Win No Fee, Motor Insurers Bureau specialists.

ClaimsMasterGroup.com

Julian Hall is the director of Claims Master Group

The Personal Injury, Accident Claim, No Win No Fee, Road Traffic Accidents specialists.

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Employers increasingly are realizing the value that worksite wellness programs deliver as an effective tool to improve employee health, increase productivity, reduce absenteeism and lower health care costs.

A 2003 report published by the U.S. Department of Health and Human Services (HHS) highlighted how important it is for employers to incorporate health promotion as part of their business strategy. The report asserts that preventable
diseases place a heavy toll on business, including lower productivity and higher health insurance costs.

The HHS estimates that $1.66 trillion was spent on health care in 2003. and it attributes a majority of those costs to chronic diseases and conditions such as heart disease, diabetes, obesity and asthma. Sadly, the money allocated for preventing or controlling these conditions is negligible.

In a recent article, American Cancer Society CEO John Seffrin reported two thirds of cancer deaths in the United States could be prevented through lifestyle changes in diet, exercise, cancer screening and “especially” tobacco use. A well-designed worksite wellness program, provided by your health benefits company, serves the best interests of both employer and employee.

Bottom line return on investment

Ron Goetzel, a nationally recognized expert in the field of health management, data analysis and applied research, said in a recent interview that with an investment of $100 to $150 per employee per year in health promotion, an employer can expect an average return on investment of approximately $3 for every $1
invested ($300 to $450 savings per employee per year).

Goetzel says, however, that these returns are not typically realized until two to three years into the wellness program.

Legislative incentives

Sen. Tom Harkin (D-Iowa) has been an outspoken proponent in seeking legislative solutions for a strained health care system.

“As a nation, we have a ’sick care’ system that is focused on helping people after they get sick, rather than a ‘health care’ system which focuses on keeping healthy people healthy,” he says.

Harkin introduced the Healthy Lifestyle and Prevention (HeLP) America Act of 2004. One of the initiatives under Title II - Healthier Communities and Workplaces, provides tax credits to businesses that offer comprehensive programs to promote employee health and grants for small business.

Worksite wellness, getting started

Implementing a worksite wellness program with your health insurance carrier can be accomplished with simple, low-cost strategies.

Offer incentives for participation.

Create a wellness campaign.

Schedule seminars on nutrition, diabetes and cholesterol.

Establish programs such as fitness, sleep diary, smoking cessation and injury prevention.

Offer chair massages or simple stretching exercises to do at the desk.

Change vending machine options to offer healthier, low-fat snacks and drinks.

Work with a health insurance carrier that can implement, manage and maintain your program. Actively promote employee participation.

A successful worksite wellness program can boost company morale, enhance productivity, reduce organizational conflict, attract superior workers and lower the rate of employee turnover. The case for establishing a worksite wellness program is well worth the effort.

CATHY AGUIRRE, vice president of account services for VISTA,
has more than 18 years of experience in managed care marketing.
She provides leadership for all of VISTA’s commercial accounts, which include Broward County Government, The School Board of Broward County, Broward Sheriff’s Office, Miami-Dade Government,
Sears, Walgreen’s and United Airlines. Reach her at http://www.vistahealthplan.com

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