Professional Medical Credentialing & Payer Enrollment Services
MANAGED CARE / PAYER ENROLLMENTS
ENROLLMENT, RE-CREDENTIALING & REVALIDATION SERVICES
Group-Level & Practitioner-Level Services
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Facilitate initial contract and application processing with PHO’s for memberships and contracted payer participations, direct enrollments with commercial insurance plans, Medicare Advantage, and government programs including each States’ Medicaid and Medicare programs.
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Timely compilation of data, preparation of all payer applications, CAQH population-to-attestation and submission of the applications at the group and the individual practitioner level.
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Reporting to payers of all practice changes, panel changes, site updates/closures, staff changes (new hires/ terminations) to keep your practice compliant under state and federal regulatory entity rules.
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Plan re-enrollments and revalidation services.
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CAQH maintenance.
Already enrolled with the payers and don't need the full complement of services??
Contracting for just our monthly CAQH profile maintenance service for participating plans’ recredentialing and to satisfy state and federal directory requirements is a wildly popular option! This service alone can give you and your staff back valuable time each month to stay focused on the practice and your patients.
Services
MEDICAL FACILITY CREDENTIALING
APPOINTMENT & REAPPOINTMENT SERVICES
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Prompt, efficient preparation and submission of facility applications to secure timely staff memberships, expediting your delivery of patient care and generation of revenue.
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Reappointment application services.
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A variety of different facility types - hospitals, long-term care centers, skilled nursing and rehabilitation facilities, and ambulatory care centers just to mention a few.
NCQA, CAQH and STATE & FEDERAL REPORTING REQUIREMENTS
Keeping health plans up to date with your demographic and practice information is vital to their members’ ability to find you and schedule appointments, and it enables plans to pay you quickly and efficiently for your services. NCQA (National Committee for Quality Assurance) standards align with state and federal (CMS) requirements for maintaining accurate plan directory information, and the No Surprises Act imposes liability for out-of-network billing when directory data is inaccurate.
Participation in the Council for Affordable Quality Healthcare (CAQH) is a requirement for most plan networks. CAQH conducts provider directory validation audits requiring every provider to attest to their information every 120 days. In fact, many health plans conduct daily file feeds from CAQH based on provider NPI’s and tax ID combinations, so it’s vital to keep your CAQH profile and directory listings up-todate. Failure to do so in some cases can result in voluntary termination from plan networks.