Submitted on Wed, 2014-04-09
By Bonnie Lu

The three biggest issues local health departments face with insurance credentialing and contracting and how to overcome them to create sustainable revenue.

Sustainable Revenue

Insurance credentialing and contracting: every local health department has to do it, but few do it effectively. Typically faced with a series of roadblocks beyond your control, the process of successfully working with payers is becoming increasingly difficult for local health departments. In our work with dozens of public health departments and community health centers across the country, we’ve identified a few common issues that if left untouched, could mean disaster for your organization.

Here are the three biggest stumbling blocks we see when it comes to local health departments working with healthcare payers:

A Seemingly Overwhelming Process

The entire credentialing and contracting process can be a daunting and overwhelming task, especially for the inexperienced. Local health departments are already trying to do the most they can under the current conditions of dwindling funding and staffing cuts. Adding credentialing and contracting to that to-do list can be a rough proposition for an already taxed staff. In order to maintain everyday operations, a local health department’s staff often cannot free up their schedule to focus on credentialing and contracting.

Communication Delays

Adding to the problems of your staff having limited time to work with payers is that the payers themselves can sometimes be unpredictable. That makes it hard to set aside a specific time each day or week to work on claims. Payers could take an exorbitantly long time getting back to you on specific cases that you may not be able to readily access anymore. Delays may also arise from the non-standard language local health departments sometimes use. In order to meet a payer’s requirements, local health departments will often have to work with the payer to revise the language. That can add even more time to a process that staff can barely focus on as it is.

Payers Just Don’t Understand

Healthcare payers are often in the dark when it comes to knowing what billable services local health departments provide. They think you’re just working for free, but that’s obviously not the case. Worse yet, some payers don’t even want to contract with public health departments because of that lack of understanding. Be persistent and let them know how beneficial it will be to contract with your local health department. With a little hat tip to DJ Jazzy Jeff and the Fresh Prince, here are some sage rhymes for everybody in public health to live by:

You know payers are the same no matter time nor place.
They don't understand what public health takes.
So to you, all the public healthers across the land.
Speak up and discuss. Make those payers understand.

Credentialing and Contracting Solutions

Add all of those issues up and it does start to look like the odds against a local health department credentialing and contracting are pretty steep. Well, looks can be deceiving. Hiring an in-house specialist or outsourcing to an experienced credentialing company are great solutions for departments that lack the time and expertise. The extra resources it may take up front for outsourcing or a specialist will make a huge difference as the revenue trickles down throughout your department. Once those insurance reimbursements come flowing in, a dedicated specialist or outsourcing will more than pay for themselves in no time at all.

If you would like to learn more about how our claims management experts can help your public health department with insurance credentialing & contracting and generating sustainable revenue, schedule a meeting today.

About the Author

Bonnie Lu works as a Healthcare Analyst for Upp Technology’s SMART Health Claims Division. Working closely with a number of health departments to improve clinic work flow, revenue enhancement, and technology advancement, Bonnie’s objective is to help local health departments better serve their community and patients. You can contact Bonnie at blu@upp.com.

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