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Commercial health insurance is provided and administered by nongovernmental entities. It can cover medical expenses and disability income for the insured. 1096 health insurers filed the statements with the National Association of Insurance Commissioners (NAIC). 

Commercial insurances are the ones that are not offered by the government like Medicare, Medicaid, State Children’s Health Insurance Plan (SCHIP), & Tricare.

Commercial enrollment is being referred to as enrollment with commercial (private) insurance companies. If you want to know more about this commercial enrolment, then, of course, you are at the right place and we will go ahead and discuss more it in detail. We will also know how CredU Global can help you with this.

The most common commercial insurance plans are HMO (Health Maintenance Organization) & PPO (Preferred provider Organization). HMO and PPO are being differentiated in terms of their functionality, in HMO plans mainly primary care physicians fail. That means when a patient wants to get the services they have to approach their PCP provider all the PCPs to hold the HMO plan and if required the PCP refers the patients to a specialist. However, the PPO plan is being held by a specialist and when a patient has OON (Out of Network) benefits, they can go directly to a specialist and the specialist can bill for their services to the insurance companies. 

Commercial enrollment is also known as the enrolment with private insurance companies in which the provider (healthcare provider) will be setting up the contracts with the private organization, it could be directly with the insurance company or it could be through IPA (Independent Physician Association) or TPA (Third part Administration). Some of the insurance companies do not prefer to deal with credentialing and contracting by themselves and they delegate this task to some other insurance company or the TPA or IPA.

Now let’s understand what is IPA and TPA- 

IPA- It is a group of physicians who set up their contracts with an insurance company and once they become contracted, they start accepting the physician and the healthcare providers to their group by offering their credentialing and contracting. In this way, the provider need not approach directly to the insurance company. An IPA is contracted with multiple insurance companies simultaneously and if you are getting enrolled with them, in this case, you have the option to see multiple insurance patients as an in-network provider. Also, you do not need to bill all those multiple insurances separately, you just need to bill only to IPA.

TPA- It is a third party that works on the behalf of the insurance company and if you are credentialed and contracted with them, the particular insurance will consider the provider as an in-network provider.

The time frame for credentialing and enrollment with the insurance companies is 90-120 days (3-4 months). 

It requires a lot of documentation to get this process done including CAQH credentialing application, credentialing application needs to be completed. If the healthcare provider is medical or behavioral then they need to have a CAQH profile to get the application processed. Commercial insurance companies use the CAQH enrollment (CAQH Proview) to process credentialing applications. As the world is getting digital, the payer credentialing process is also going digital on the daily basis. Earlier most of the insurance companies were using paper applications to complete the provider enrollment process however now they are turning their process based on the caqh enrollment. The moment we apply for the payer credentialing process or the payer enrollment, they ask for the CAQH information to process. They pull the information from the CAQH profile and process the application from there. CAQH enrollment is mandatory before we apply for any payer enrollment. All the payers are removing their paper application method and moving towards the digital world. Everyone is trying to delegate the work to someone else, and the payers are also doing the same by putting the work of updating the CAQH profile on the provider’s head and if the CAQH profile is not completed by 100%, they reject the application on the spot. CredU Global is a team of highly qualified people who can easily handle this task very easily and our success rate is more than 99%. 

Provider enrollment is a process in which the provider has to work consistently with the insurance companies to get their enrollment process completed and even after working with them continuously, it is not sure that they will complete the payer enrollment process. Credentialing company plays a very vital role in this entire credentialing and enrollment process because they know all in and out of the process and they are also aware that what the situation could be and how to fix the issues to get the results flawlessly. Call CredU Global now to schedule a free consultation call at (516) 405-4969 or you can email us at info@creduglobal.com regarding the payer enrollment. Medical credentialing requires the following information to move forward- NPI, TIN, Specialty of the provider, DOB, Place of birth, State license, DEA license (if available), Malpractice insurance (PLI/GLI), W-9 form, CAQH number, Service location, etc. 

There is N number of insurance companies out there in the entire country but the healthcare provider is the one who needs to take the decision with whom he wants to start with. Credentialing and enrolment is a process that doesn’t get completed by the overnights, it does take some time off at least 3-4 months to complete, and sometimes more than that. The best thing is to get this done by one of the top healthcare credentialing companies and CredU Global is one of them. 

Here is the list of the top 25 health insurance companies based on the market share-

1. United Healthcare

2. Kaiser Foundation

3. Anthem Inc.

4. Centene Corporation

5. Humana

6. CVS

7. Health Care Service Corporation (HCSC)

8. CIGNA

9. Molina Healthcare

10. Independence Health Group

11. Guidewell Mutual Holding

12. California Physicians Service

13. Highmark Group

14. Blue Cross Blue Shield of Michigan

15. Blue Cross of California

16. Blue Cross Blue Shield of New Jersey

17. Caresource

18. UPMC Health System

19. Health Net of California

20. Carefirst Inc.

21. Blue Cross Blue Shield of North Carolina

22. Metropolitan

23. Local Initiative Health Authority

24. Blue Cross Blue Shield of Massachusetts

25. Blue Cross Blue Shield of Tennessee

• List of the top 5 insurance companies across the entire country based on the membership-

1. United HealthCare (UHC)- UHC has 70 million active members across the entire nation. They have a network of 1.3 million physicians and healthcare physicians with more than 6,000 hospitals. Its coverage can be availed in all 50 states.

• Anthem- Anthem is the second-largest health insurance company in the entire country with 39.9 active members. Anthem works in all lines of business including Medicare, Medicaid, HMO, PPO, EPO, POS, etc. It is a licensee of Blue Cross Blue Shield (BCBS) and they operate in the states of California, Kentucky, Connecticut, Georgia, Colorado, Indiana, Wisconsin, Maine, Missouri, Nevada, New York, New Hampshire, Ohio, and Virginia. 

• Aetna- Funded in 1853, Aetna is the third-highest insurance based on the size of the membership. They have close to 22.1 million members in the entire nation.

• Cigna-  Cigna is the fourth largest company in the United States based on the size of the membership, they have 20.4 million members across the country. They are serving individually in the states of North Carolina, Arizona, California, Georgia, Colorado, Florida, Maryland, Missouri, Tennessee, and South Carolina.

• Humana- The insurance was originally funded in 1961 and it is the fifth-largest insurance in the country with 16.6 million-member size.

• List of the largest insurances based on the state-

Alabama	Blue Cross Blue Shield of Alabama
Alaska	Premera Blue Cross
Arizona	Centene Corp.
Arkansas	Arkansas Blue Cross Blue Shield
California	Blue Shield of California
Colorado	Kaiser Foundation
Connecticut	EmblemHealth
Delaware	Highmark
District of Columbia	CareFirst
Florida	GuideWell
Georgia	Centene Corp.
Hawaii	Hawaii Medical Service Association
Idaho	Blue Cross of Idaho
Illinois	Health Care Service Corp.
Iowa	Wellmark Inc.
Indiana	CareSource
Kansas	Blue Cross Blue Shield of Kansas
Louisiana	Louisiana Medical Service and Indemnity
Kentucky	Anthem Inc.
Maine	Maine Community Health Options
Massachusetts	Tufts
Maryland	CareFirst
Michigan	Blue Cross Blue Shield of Michigan
Minnesota	HealthPartners
Missouri	Cigna
Nebraska	Medica
Montana	Mountain Health Cooperative
Nevada	UnitedHealthcare
New Jersey	Horizon Blue Cross Blue Shield of New Jersey
New Hampshire	Anthem Inc.
New Mexico	Molina Healthcare Inc.
North Carolina	Blue Cross Blue Shield of North Carolina
New York	Mulberry Health
North Dakota	Noridian Mutual Insurance Co.
Oklahoma	Health Care Service Corp.
Ohio	Medical Mutual of Ohio
Oregon	Providence Health
Rhode Island	Neighborhood Health Plan of Rhode Island
Pennsylvania	Independence Blue Cross
South Carolina	Blue Cross Blue Shield of South Carolina
Tennessee	Blue Cross Blue Shield of Tennessee
South Dakota	Wellmark Inc.
Texas	Health Care Service Corp.
Vermont	Blue Cross Blue Shield of Vermont
Utah	IHC Inc.
Virginia	Cigna
West Virginia	Highmark
Washington	Kaiser Foundation
Wisconsin	Common Ground Healthcare Cooperative
Wyoming	Blue Cross Blue Shield of Wyoming

• List of the insurance companies based on the revenue-

Rank	Company	Revenue
1	United Healthcare	$257 billion
2	Anthem	$122 billion
3	Centene	$111 billion
4	Kaiser Permanente	$89 billion
5	Humana	$77 billion
6	CVS Health	$75 billion
7	HCSC	$47 billion
8	Molina Healthcare	$19 billion