Contracting  and Credentialing Solutions

Credentialing is an essential part of healthcare and is highly regulated at the state, federal, and payer levels. Credentialing programs must comply with accrediting body standards.

 

Health systems continue to grow and consolidate, the demand for solutions that guarantees quick turnaround times, quality oversight, and compliance are now a requirement.

 

Some practices/facilities lack expertise in this area because it is a function that is not performed with much regularity. 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.

 

With increased government regulations, payer specific requirements, and a general lack of industry standardization in this area all contribute to making credentialing more complicated for on-site staff.

Who We Work With...

  • Ambulatory Surgery Centers (ASC)

  • Audiologists

  • Behavioral Health Providers

  • Chiropractors (DC)

  • Clinical Laboratories

  • Dentists/ Orthodontists

  • Diagnostic Testing Facilities (IDTF)

  • Hospitals

  • Optometrists

  • PAs/ NPs

  • Physicians

  • Podiatrists (DPM)

  • PT/OT/SLP

  • Sleep Labs

  • Urgent Care Facilities

  • Many More

Provider Credentialing Services

  • Management and Oversight services

  • Initial Hire Packet and Enrollment design

  • NPI Registration

  • Provider/Group enrollment assessment

  • CAQH maintenance and updates

  • Medicare, Medicaid and commercial carrier Enrollments

  • Out-of-State/Regional Payer Enrollment Services

  • “Change-To” Address Services

  • Facility Address Update/Change Services

  • Application follow-up and updateS          

  • PECOS Assessment and Management

Provider Enrollment Forms

Re-Credentialing Services:

  • Managed Based on Individual Payer 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 Payer Legacy Provider ID Numbers Consolidation

  • Medicare Revalidation

Credentialing Services Benefits

  • 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

Helping You Manage Your Largest Asset...