For practice managers, healthcare providers, and owners, understanding and meeting urgent care center contract requirements is crucial. Therefore, successful credentialing depends on fulfilling these key criteria before submitting contracts to payers or health systems. Ultimately, compliance matters significantly for your business.
Operational and Safety Standards
An urgent care center must maintain specific operating hours. Specifically, weekday hours should extend until at least 7:00 PM. Weekend availability significantly improves contract approval chances. Moreover, certain payers may require holiday coverage. Additionally, display your hours in all marketing materials.
Emergency preparedness is mandatory. If your center operates independently, you need to implement several safety measures. Keep an AED (Defibrillator) on-site and properly maintained. Furthermore, you must train staff in basic life support (BLS) and emergency response protocols.
Identification and Documentation
Your facility must secure proper identification. First, a unique Tax Identification Number (TIN) is necessary. Next, the facility requires a separate National Provider Identifier (NPI). Group practices must establish distinct credentials for their UCC location.
When applying, prepare and submit essential documents. This includes a completed Urgent Care Center Summary. Also, submit proof of state business registration and current licenses. You must include malpractice insurance certificates with adequate coverage.
Billing Compliance Essentials
For efficient claims processing, follow specific billing guidelines. Submit professional services claims using CMS-1500 forms exclusively. Avoid combining institutional charges (CMS-1450) with UCC services. Crucially, include proper place-of-service (POS) codes (20 for UCC) on all claims.
Meeting these standards offers significant benefits. It accelerates credentialing approval, often reducing the wait from 90+ days to 30-60 days. This also increases reimbursement rates from contracted payers. In short, proper documentation reduces claim denials and enhances patient access.
Conclusion
Mastering urgent care center contract requirements is essential for business viability. Consequently, focusing on operational, safety, and billing compliance ensures faster credentialing. This structured approach secures network participation and drives long-term revenue growth.