Workers’ Compensation Contracting—or Workmans' Comp Credentialing—for Doctors is the process of contracting a medical practice with a Workers' Compensation payer for the purpose of increasing patient referrals to that practice. Depending on the state, Doctors are often required to be contracted with a specific carrier, network, or panel in order to receive referrals from Workman's Comp payers.
Having an agreement also helps to ensure the fee schedule is agreed upon in advance, while also clarifying other understandings between the doctor's office and the insurance carrier.
In managed-care states, insurance companies and employers will only refer injured workers to your practice if you are credentialed with them or a designated network or panel.
Even if you are already listed on most networks and panels, it is important to check that you are listed correctly. Provider lists often have multiple tags and search terms, so you need to ensure that your listing is optimized and that you are showing up for all possible terms. A good example is 'PM&R' where the doctor may be listed under 'physiatry', 'PM&R', or even 'interventional pain management'.
Additionally, with all the recent mergers in the sector, even basic information such as phone numbers and email addresses should be checked. This is even more important if you have changed any of your details in recent years.
Not happy with your current reimbursement for treating work-related injuries? No problem—in many states it is possible to renegotiate this with the network, TPA, or insurance carrier.
In addition to credentialing your practice with networks, you can also contract individual physicians with IME panels. While the reimbursement for IMEs varies considerably, many panels allow you to set your own rate. However, of course, setting a very high rate will reduce the chances of IME referrals.
Yes, there is a list of Workers' Compensation Networks, although it varies slightly between states. To obtain this list, please Contact Us.
Many states have their own Workers' Compensation Fee Schedule. This essentially dictates the rates that doctors and medical providers can be reimbursed for the treatment and evaluation of injured workers. The fee schedules list the rates according to ICD codes.
Interested in obtaining the fee schedule for your state? Contact us.
Many workman's comp networks allow you to contract the entire practice rather than just a single physician. A key advantage of this is that, even if a certain physician leaves your practice, you as the practice owner remain in control of the workers' comp contracts.
This varies from network to network. Some require you to credential both Doctors and PAs, while others only require the Doctors to be credentialed.
There are many Independent Medical Examination (IMEs) Panels. These panels are often independent entities that specialize in offering IMEs, although some insurance carriers also have their own 'in-house' IME lists. Credentialing doctors with IME panels greatly increases the chances of receiving IME referrals. Most IME panels have their own online credentialing forms. If you would like help adding a Doctor to all the IME panels in your state, please Contact Us.
CAQH—or the Council for Affordable Health Care—is a non-profit alliance of healthplans with the goal of simplifying the process of physician credentialing. Put simply, it provides a shared online location for physicians to share their information, rather than having to enter it multiple times in credentialing paperwork. Read more about CAQH.
It is not uncommon for insurance carriers and TPAs to place restrictions on the ancillary services that doctors can offer their patients. Examples of ancillary services are medications, Durable Medical Equipment, and Medical Devices. These restrictions may sometimes be mentioned in the agreement you sign with them so be sure to read the contract thoroughly before signing.
Workers-Compensation-Doctors.com is one of the most affordable providers of workman's comp credentialing for doctors and medical practices. Credentialing is included as part of our Workers' Compensation Marketing Service, but it can also be offered as a stand-alone service.