The Choice of IPA Providers as a Vital Step in Credentialing


When it comes to medical credentialing, one crucial decision that practitioners must make is choosing the right Independent Practice Association (IPA) provider. The process of finding the ideal IPA provider can be a nuanced journey, but understanding how to navigate it effectively is essential. We decided to explore the key factors to consider when determining the right IPA provider for your credentialing needs and how to find them.

Direct Communication is Key

To begin your journey toward selecting the right IPA provider, it is paramount to engage in direct communication. It means scheduling a Zoom call or meeting with the IPA providers themselves. During this interaction, your objective should be to get to know them and understand their specific requirements and regulations, as well as any current limitations they may have.

Even if an IPA is well-established and works with numerous insurance plans, they are still subject to the regulations set forth by insurance companies. If an insurance company decides to close its panel for a specific specialty, the IPA will adhere to these regulations and may not extend that specialty. However, the IPA might still enroll and approve you independently and assign you to various plans. It's vital to comprehend that approval by the IPA does not necessarily guarantee approval with all the plans they manage.

Ask the Right Questions

During your communication with the IPA provider, you should ask a series of pertinent questions to ensure that you make an informed decision:

  1. Specialty Acceptance: Inquire about which insurance plans will not accept your specialty and which ones are open to it. This information is crucial for planning your credentialing strategy.
  2. Credentialing Timeframe: Understand the expected timeframe for the credentialing process. This knowledge is vital for planning your practice's operations and patient appointments.
  3. Plan Availability: Identify the insurance plans they offer and evaluate whether they align with your practice's goals and patient demographics.

Why Choose WCH?

When it comes to reviewing and selecting IPA providers, consider partnering with WCH. Our expertise lies in assessing IPAs, evaluating their availability in your state, reviewing contracts, and understanding the range of plans they provide.

Furthermore, our team at WCH can assist you in engaging with IPA providers. We can join you in conference calls to help you navigate the complexities of their requirements and limitations, ensuring that you are fully prepared for the credentialing process.

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