Pharmacists are now eligible to become credentialed providers with payers nationwide.
As a licensed pharmacist, I have recently completed the credentialing process with Arkansas Blue Cross & Blue Shield and would like to share my experience to assist other pharmacists in starting their own provider journeys.
Here are 5 tips that can help the credentialing process move forward more smoothly.
1. Stay organized
There’s a lot of information that needs to be submitted during the credentialing process.
Here are a few pieces of information that were required for an individual application.
- Proof of Liability Insurance (minimum $1/$3M coverage)
- Proof of pharmacist license in good standing
- CV/Resume with work history (all gaps accounted for)
- Individual provider NPI number
- Provider Application with Payer
- Network Application with Payer
- EFT agreement with Payer
Staying organized using a Dropbox or Google folder will save you time and energy if you need to resubmit information that gets missed during the application process.
Working with a single point of contact with the payer is also highly recommended.
My BCBS point of contact was the provider relations specialist for my region and we stayed in contact via email throughout the process.
Having a single point of contact is essential through the novel process of pharmacist credentialing.
2. Plan ahead
I first submitted my provider application in May and only recently received notification of my approval at the end of August.
Medical billing for pharmacists is novel to both our professional and the payer professionals, so stay resolved and positive.
At a minimum, the process takes 90 days, but due to the ‘newness’ of this opportunity, plan well ahead in case your application needs to be resubmitted.
3. Consider organizational goals
When identifying where to focus your efforts in medical billing, I advise my clients to look at the opportunities they already have in their state.
In Arkansas, for example, we have a “test and treat” protocol that allows pharmacists to prescribe medication for the treatment of influenza or strep after a positive point-of-care test.
Pharmacists in many states also have the ability to prescribe oral contraceptives, naloxone, and other medications for low acuity conditions.
Understanding your state’s scope of practice and statewide protocol opportunities can help you align your efforts with the goals of the payers and clinics in your local area.
These opportunities give local pharmacies a chance to differentiate themselves from the competition.
4. Prioritize programs
The biggest mistake that I see consultant pharmacists make is trying to do too many things.
Yes, you can set up point-of-care testing programs, pharmacogenomics programs, and chronic care management programs in a community pharmacy.
However, if you try to do everything, everywhere all at once, your focus will be divided and your results will also be divided.
Prioritize which programs you want to focus on and champion those. I recommend at least 6 to 8 months of focus per project.
5. Trials and Errors
Working with a platform like DocStation can help pharmacists overcome the steep learning curve of medical billing.
There is still much to learn as pharmacists begin to shift their revenue streams from product-oriented to value-based services.
Pharmacists now have provider status in many states, though federal provider status remains in legislative limbo.
With proper payer credentialing models in place, pharmacists are able to work within their scope of practice to deliver and bill for acute care services to help patients with self-care and lifestyle medicine.
Independent pharmacies facing financial challenges can benefit from medical billing to broaden their revenue sources, enhance the wellness of the community, and provide excellent acute care services.
