Autism Contracting & Credentialing

Autism centers  are faced with a challenge of becoming an in-network provider for the insurance companies.  The steps to become an in-network provider can be very frustrating.  The confusion is creating a great demand for companies like Artemis Medical Solutions, that have the experience and knowledge to get you in-network.

Why do you/center have to become an in-network provider?

If you are not an in-network provider, insurance companies can deny paying for services.  With HMO, the networks become more of a trend, they will have the ability to deny payment.  With PPO network, they have coverage for out of network, but the insured is looking at double out of pocket max.  Insurance companies are now assessing,  a daily penalty for out of network services. The option of getting a single case agreement is no longer an easy and cost effective solution. We are also starting to see where the insurance company, will inform the insured, of a facility that is in-network.

Why is becoming an in-network autism provider so frustrating?

With the explosion of new state mandates covering autism services, insurance companies are trying to control risk. One way of control risk, is limiting the amount of autism providers in their network.  We have also seen a reduction in trained customer service reps in the insurance industry. There is no benefit to the insurance industry to make this process easy.

Why is Artemis Medical Solutions is an expert on autism contracting?

Here in Indiana, we have been very fortunate to have a great autism mandate passed back in 2002. This has given us real life experience with contracting and credentials.  We have learned the dos and don’t to this process. Each carrier will change the requirements for contracting and they don’t release this information.  To adapt to these new requirements, we use our leverage from dealing with the insurance companies on a daily basis. We have built relationships with key employees at the insurance companies, so we know what is required before we submit on behalf of a client.

Why hire Artemis to perform your contracting?

Because you need to be in-network as soon as possible.  You don’t have the time to dedicate to this process.