Provider Credentialing And Enrollments

➥ Documentation

➥ Verification

➥ Payor Submission

➥ Enrollments

➥ Re-Credentialing

PROVIDER CREDENTIALING PROCESS INVOLVES THE FOLLOWING:

✓ Collecting all the data and documents from the physicians that are required for filing credentialing applications.

✓ Documents are stored centrally on our secure document management systems

✓ Understand the top Payors to which the practice sends claim and initiate contract with the Payors.

✓ Apply the payor-specific formats after a due audit.

✓ Timely followup with the Payor to track the status of application.

✓ Obtain enrollment number from Payor and communicate the status of application to physicians.

✓ Periodic updates of documents for credentialing purposes.

Our Provider Credentialing Services Include

New Registrations/Renewals of an Individual Provider

✓ With the State

✓ With the Drug Enforcement Agency (DEA)

Provider Data Maintenance - Update Management on Payor Systems

✓ Provider demographic update in payors file. (Updating Provider specialty or any additional educational qualifications).

✓ Provider directory maintenance on payor websites. (Checking payor website and verifying provider details like Phone and Fax #, Zip code. Updating the correction to payors )

✓ EFT/ERA enrollments

Contracting Creation and Maintenance

✓ New Group/Individual Provider contracts.

✓ Adding/Deleting providers in the existing contract

✓ Adding/Deleting location in the current contract

✓ Adding/Deleting plan types (Line of Business) in the current contract

CAQH Attestation

Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative processes between health plans and providers for credentialing, directory maintenance, coordination of benefits, and other essential business functions.

✓ CAQH application filing

✓ CAQH quarterly attestations

Expirations and Renewals

✓ The tracking expiry date for State DEA License, Board certificate, and Malpractice Insurance

Tracking and Analytics

✓ Maintaining a repository of provider’s credentialing documents.

✓ Maintaining Contracting agreements

✓ Tracking credentialing dates, expiration, and alerting dates to initiate credentialing processes

✓ Working with the denials team to understand if there are any claim denials due to credentialing issues