Patients who purchase individual health insurance coverage or are supplied such coverage through an employer typically are covered by a commercial health plan. Commercial health plans come in many varieties and have varied implications for an individual health provider. Varieties may include traditional indemnity plans, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and high deductible plans (a component of Health Savings Accounts).

As with governmental plans, participation with a commercial health plan requires enrollment by the health provider. The enrollment process includes completing an application, with supporting documentation for that health plan, which verifies the credentials and representations of a provider. In some instances, health plan inspections of provider facilities and other procedural steps may be included in the enrollment process. The provider application can be health plan specific or can follow an adopted state uniform format. Complete an individual enrollment application for each health plan, for which you intend to participate, to service their patients.

Completing an enrollment application, with redundant information for each commercial insurance plan that a health provider wishes to participate, can be time consuming and onerous. A solution was established to provide a central consolidated online repository for provider credentialing information which can be shared by multiple participating health plans. That repository is the Provider Data Portal maintained by the Council for Affordable Quality Healthcare (CAQH), a not-for-profit. Click here to register with the CAQH PDP and begin aggregating your data.

When enrolling with a commercial insurance plan, a health provider, in most instances, will need to designate whether they intend to practice as a primary care physician or a referral specialist. The selection of primary care versus specialist is critical for determining such issues as health provider payment and obtaining or issuing authorizations for approved services.

Commercial health insurance plans with the greatest beneficiaries may include your regional Blue Cross / Blue Shield plan (which may use brand name other than BC/BS), UnitedHealthcare Group, CVS Health (formerly Aetna), Cigna, Humana and Kaiser Permanente.

To save your commercial enrollment information, register, log in and go to the Practice Preparations section behind our secure firewall.