In-Network vs Out-of-Network Insurance 

Healthcare providers venturing out into private practice often don’t know how to deal with the process of getting paid for services. They’re understandably unfamiliar and can feel a sense of confusion surrounding billing and insurance. Healthcare providers are typically not taught about healthcare billing in their training, so this is an area that needs to be addressed in order to succeed in their offices. 

Creating a revenue cycle for your practice can be a difficult process, but with some advance planning and a bit of research, you will feel much more confident about the entire process.

First things first, you need to understand the difference between in-network and out-of-network insurance companies, how they operate, and why it’s integral to have insurance credentials. Without insurance credentials, you won’t be paid for the medical services you provide to your patients. 

What is the Difference Between In-Network and Out-of-Network Insurances?

Health insurance is an important topic for many people. However, it can be tricky to understand the difference between in-network and out-of-network coverage. It’s easier to comprehend than you think. When patients find you, you’ll either be in-network or out-of-network. 

In-network coverage is when a person goes to the healthcare provider that they have chosen to be in their network. This means that they will not have to pay any more out-of-pocket expenses for the medical care that they receive. As a provider, you want to be in-network with as many insurance companies as possible. Patients prefer to go to providers that are in-network. 

Out-of-network coverage is when a person goes to a healthcare provider outside of their network. This means that they will have to pay more out-of-pocket expenses for the medical care that they receive. Patients are less likely to go to providers that are out-of-network. 

Why Is Insurance Credentialing Important?

The credentialing process for insurance is an important process for a number of different reasons. For starters, it ensures that the person applying for a license is qualified to do so. 

This can reduce instances in which unqualified individuals represent themselves as licensed professionals, which in turn can provide consumers with false information and potentially cause them to make bad decisions. 

You should consider what insurance companies you would like to contract with. Some major insurance companies are Blue Cross Blue Shield (BCBS), Medicare/Medicaid, United Healthcare, Cigna, and many more. You will have to fill out an application for each insurance company that you want to be in-network with. 

These applications can easily take around 2-6 hours to complete. This is where a medical billing company can provide some assistance. Hiring a medical billing company can help you with insurance credentialing applications and speed up the complicated process. 

Get Professional Streamlined Medical Credentialing 

Credentialing with insurance is a lengthy, time-consuming process. If you’re looking for professional streamlined insurance credentialing, you’ve come to the right place. Here at AMS Solutions, we take medical and insurance credentialing very seriously. 

AMS Solutions is a leading provider of credentialing services in the insurance industry. No matter what insurances you are looking at, we’ll make sure you get contracted with them. 

Let us take care of all of your medical credentialing needs with quickness and efficiency. We know you don’t have the time required for proper medical credentialing, which is why we’re here to save you time and money. 

Send us a quick message here, or feel free to call us anytime at 214-522-0210. We’re so excited to hear how we can help you and learn more about your private practice!

We also offer free practice audits for your convenience. 

AMS Solutions

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