How Urgent Care Centers Can Navigate Insurance Credentialing Challenges During the Fall Flu Season

Essential Tips and Best Practices for Managing Insurance Credentialing When Patient Volume Surges

Fall begins on September 22, and it's one of the busiest times for urgent care centers. The Urgent Care Association (UCA) reports that patient volume spikes during the fall due to flu season and increased demand for vaccinations and respiratory treatments. Managed Care Organizations (MCOs) and insurers also encourage patients to use urgent care centers for non-emergency needs.

Preparing for peak seasons involves many steps to keep your center running smoothly and meeting patient demand. This includes stocking medical supplies, ensuring adequate staffing, and improving scheduling and communication tools. But one key area often overlooked is credentialing. Ensuring all providers are credentialed with the necessary payors is essential to maintaining service levels and maximizing reimbursements.

Do You Have a Credentialing Resource on Staff?

Before diving into specific steps for peak seasons, ask yourself: Does your urgent care center have a dedicated credentialing resource? Many centers do not. Instead, they rely on administrative staff or clinic managers who juggle credentialing with other duties.

This often leads to delays and inefficiencies, as highlighted by the UCA, which can be particularly problematic during high-demand periods like the fall flu season​.

If your center lacks a credentialing specialist, consider the value of partnering with a professional service. Such a partnership can save time, reduce errors, and ensure your providers are fully credentialed as patient demand grows.

Below, we’ve compiled a list of practical tips for managing insurance credentialing effectively. As you review these tips, consider whether handling these tasks internally is the best use of your resources or if outsourcing might be the smarter approach.

Tips for Managing Insurance Credentialing: In-House Strategies and Professional Support

1. Assess Your Credentialing Status

• In-House Strategy: Start by making a detailed list of all providers and their current credentialing status. Identify any gaps or pending applications that require immediate attention. Schedule regular time for administrative staff to focus solely on these tasks.
• Professional Support Insight: Many credentialing services use specialized software to track and maintain provider credentials, ensuring nothing is missed. For example, pie Health offers a credentialing management platform that automatically updates credential statuses and alerts you about upcoming renewals, reducing manual tracking efforts and minimizing errors.

2. Streamline Your Credentialing Processes

• In-House Strategy: Automate tasks like document collection, reminders, and data entry to reduce errors and save time. Consider investing in a centralized, secure database to store credentialing information, which can be easily accessed for verification and claims processing.
• Professional Support Insight: Credentialing services often provide integrated software solutions that automate these processes and provide real-time updates. At pie Health, we use advanced automation tools to streamline credentialing workflows, minimizing human error and speeding up the overall process.

3. Communicate with Providers and Insurers

• In-House Strategy: Establish clear communication channels with your providers and insurers. Develop a straightforward FAQ or guide that outlines the credentialing process and addresses common questions. Conduct regular check-ins to ensure everyone is aware of deadlines and requirements.
• Professional Support Insight: Professional credentialing services maintain direct communication with insurers and providers, leveraging established relationships to quickly resolve issues. At pie Health, we handle all communication, reducing the administrative workload on your team and ensuring smooth, efficient processes.

4. Use Technology to Improve Patient Flow

• In-House Strategy: Utilize online registration and check-in tools to streamline operations and manage patient loads effectively. Real-time tools can help track credentialing and patient management, allowing for quick responses to any issues that arise.
• Professional Support Insight: The best credentialing services companies ensure that all providers are properly credentialed for both in-person and telehealth services, maximizing patient capacity. pie Health offers credentialing support for telehealth providers, helping your center expand service offerings without the associated administrative burdens.

5. Prepare for Future Busy Seasons

• In-House Strategy: Use historical data to forecast demand for different services and align your credentialing and staffing strategies accordingly. Stay proactive by monitoring regulatory changes that could impact credentialing requirements.
• Professional Support Insight: Professional credentialing services like pie Health stay updated on all regulatory changes, adjusting your credentialing strategy as needed. This helps your center remain compliant and ready for any future increases in demand.

6. Protect Your Revenue Cycle

• In-House Strategy: Keep your billing team informed about credentialing statuses to prevent claim denials due to expired credentials or missing information. Use quieter periods to negotiate contracts with insurers, preparing for future demand.
• Professional Support Insight: Credentialing services manage communications with payors and handle resubmissions for denied claims, maintaining a steady revenue flow. At pie Health, we monitor and manage claim submissions, helping reduce denial rates and protect your financial health.

7. Keep Staff Informed and Ready

• In-House Strategy: Regularly train staff on the credentialing process and offer refresher sessions to keep everyone up-to-date. Cross-train team members to handle credentialing tasks, ensuring you’re covered if key staff members are unavailable.
• Professional Support Insight: Credentialing professionals provide ongoing support, training, and expertise to manage complex scenarios effectively. At pie Health, we offer continuous education and support, helping your team stay informed without the additional strain.

Maximizing Efficiency and Reducing Stress with the Right Support

Managing insurance credentialing is crucial for any urgent care center, particularly during high-demand periods like the fall flu season. Without a dedicated credentialing team, many practices find themselves overwhelmed by the complexities involved, which can result in errors, delays, and lost revenue. The Journal of Urgent Care Medicine underscores that poor credentialing management is a leading cause of denied claims and cash flow disruptions.

Ensuring that all providers are fully (and currently) credentialed can constitute a full-time job for a moderate-sized urgent care operation—labor many operations cannot afford. Consequently, many urgent care operators choose to outsource this process as needed. 

Rather than leaving your staff to navigate these complexities alone, consider the benefits of partnering with a professional credentialing service. Services like pie Health use specialized tools and expert knowledge to streamline credentialing processes, reduce errors, and ensure all providers are fully credentialed on time. This partnership allows your team to focus on delivering high-quality care while maintaining a strong financial foundation.

Moreover, professional support offers benefits that extend beyond the immediate season. Credentialing experts monitor regulatory changes, help prevent claim denials, and enhance overall efficiency, resulting in fewer administrative headaches and more reliable revenue streams. With the right partner, your practice can stay prepared for any future busy period, from flu surges to school physicals.

As you look ahead to the coming months, think about whether managing credentialing in-house is the most efficient use of your time—or if it might be more effective to work with experts who can help your practice thrive year-round. With professional credentialing services, you gain confidence knowing your providers are properly credentialed, your claims are managed accurately, and your practice is set up for ongoing success.

To learn how pie Health can simplify your credentialing process, contact us today. We’re here to support your urgent care center with tailored solutions that meet your specific needs and help ensure a smoother, more profitable future.