Our Services
Credentialing
We Answer Your Credentialing Needs
We understand first-hand the impact provider credentialing has on cash flow to an organization. Trying to understand and manage credentialing is a tedious and time-consuming endeavor that rapidly consumes staff resources. Understandably so, the majority of practices lack expertise in this area because it is a function that is not performed with much regularity. In addition, the lack of the necessary tools to properly and pro-actively manage the credentialing process leads to reactionary measures that are enacted only when claims begin to deny due to Non-participating and/or Out of Network issues. Increasing government regulations, payer specific requirements, and a general lack of industry standardization in this area all contribute to making credentialing predisposed to pitfalls.
Customized Credentialing Solutions
We understand that each practice is unique when it comes to its requirements for credentialing services. That’s why we create customized solutions that allow us to consult, supplement, or provide fully managed credentialing services. Some of the customized solutions we offer include:
- Management and Oversight services
- Initial Hire Packet and Enrollment design
- Provider/Group enrollment assessment
- CAQH maintenance and updates
- Medicare and Medicaid Enrollment
- Out-of-State/Regional Payer Enrollment Services
- “Change-To” Address Services
- Facility Address Update/Change Services
Expirable Document Management Services:
- Pro-Active Monitoring and Notification of Expiring Documents (e.g., Professional License, DEA, Board Certification, CME Hours)
- CAQH Re-Attestations (every 120 days)
- Expiring Document Notifications and Reporting
- Facilitate Claim Issue and Edits related to Provider Enrollment Issues
Re-Credentialing Services:
- Managed Based on Individual Player Requirements
- Application and Signature Page Consolidation and Management
- Applications Sent and Tracked to Confirm Delivery and Receipt
- Regular Application Follow-Up and Updates
- NPI and Player Legacy Provider ID Numbers Consolidation
- Medicare Revalidation
New Providers
One of the most frustrating parts for new providers is the amount of time and number of requests they receive from staff that inexperienced with credentialing. The continual harassment stems from lack of experience knowing what payers will request and want to see on credentialing applications. This back-and-forth is also expanding the amount of time it is going to take to get a provide credentialed.
We have developed a proprietary Provider Enrollment Packet to facilitate the gathering of required provider information and documents to credential a new provider as expeditiously as possible. The Provider Enrollment Packets provides us with the vast majority of information we will need to fill out all the payer applications and get them submitted to the payer while eliminating all of the back-and-forth with the provider.
Begin The Process Early
Although there are some payer limitations on how early you can submit credentialing paperwork for a provider – start the process as early as possible. Often times credentialing can be completed within 90 days with most payers but give yourself as much time as possible. As payers expand their enrollment requirements to include Non-Physician Practitioners (NPP) the enrollment timelines have lengthened tremendously. In addition, as payer’s merge and consolidate operations the days of being able to “pull strings” and expedite paperwork are becoming a thing of the past.
The Details Matter
Review the information you have obtained from the provider and scrutinize everything.
CAQH Profile + CVS
Dates and time-lines on CV’s should clearly line-up and gaps in time should be addressed.
Ensure information on payer applications is legible.
Copies of licenses and certificates must be clear and decipherable.
CME Hours
Use the correct color pen. As petty as it sounds there are payers that will reject applications if information and signatures are not in blue ink.
It’s estimated that over 80% of applications submitted are missing important information that is need for a payer to properly process an application.