Insurance Credentialing Setup

Clinicient Insight’s credentialing feature is designed to track insurance credentialing by individual therapist and clinic. This eliminates inadvertent billing for services that are not performed by properly credentialed therapists.

Note: All users are responsible to comply with any insurance provider contracts and any local, state and federal regulations dealing with provider credentialing and/or licensing. The Compliance Officer for your organization should take any existing government regulations and payer contracts into account before making any setting changes.

  1. Click and select the General Billing Data tab.
  2. Select the Requires Credentialing for Caregivers check box if payer requires individual therapist credentialing. The Provider Credentialing section appears at the bottom of the window.
  3. Check the Provides Caregiver Credential # check box if the payer requires the credential provider number for billing.
  4. Click Add and add staff members credentialed with the payer. Add individual provider numbers if a provider number is required.

In multiple clinic organizations, the therapist may not have provider numbers for all of the clinics in the organization or different numbers for various clinics in the organization.

Click the Clinics when necessary to enter the appropriate clinic-specific provider numbers. Optionally use the paper clip icon to attach a copy of the approval form from the insurance company.

Therapists who are not credentialed with all clinics within your organization are differentiated by the blue background from those that are credentialed providers for all clinics.

Some payers may assign a common provider number to be used by one provider for all insurance plans of that type. Examples include some Blue Cross plans and Medicare. The common provider number may be used only when a specific Claim Type is declared in Billing as illustrated here (General Billing Data tab in the Edit Payer form). Claim Type provider numbers may be listed in the settings for each individual staff member.

Staff Settings

Credentialing settings may be reviewed and confirmed in the Staff Settings which may be accessed in either EMR or Billing as illustrated here.

Credentialing Tab

Credentialing Settings may be confirmed for all staff members by using the Credentialing button. This may be accessed by selecting File-Payers from EMR or by selecting Edit Payers in Billing.

Any of the columns may be filtered or sorted to give summary information on credentialing across the entire staff. For example, to see all insurance plans that require credentialing, along with the credentialing settings for all therapists, click on the down arrow to filter the Credentialing Required column as illustrated here.

Company Info and Clinic Management Settings for Credentialing

  1. Select the Require cosign for non-evaluation appointments check box if you would like the supervising therapist to manually cosign all notes for a staff member that is set to require cosign. If this is set documentation automatically routes to the supervising therapist for an additional sign off.
  2. Clear tthe Require cosign for non-evaluation appointments check box if you would like the supervising therapist to manually cosign evaluation appointments only.

When a non-credentialed therapist signs off on an evaluation, they will be prompted to select a supervising therapist to route the visit to for additional sign off. When the therapist signs off on a non-evaluation appointment, they are still required to select a supervising therapist but the system does not automatically route it to the supervising therapist for sign off. In this scenario charges automatically get sent to billing but show the caregiver as the non-credentialed therapist and the supervising therapist as the Supervisor.

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