As a Revenue Cycle Management Company (RCM) 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.
• Participating And Non-participating Payer
• Analysis Demographic And Documentation Review
• Payer Application And Signature Page
• Consolidation Applications Sent And Tracked To Confirm Delivery And Receipt
• Regular Application Follow-up And Updates
• Npi And Payer Legacy Provider Id Numbers Consolidation
• Pecos Assessment And Management
Med USA understands 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:
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.
Med USA has 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.
Although there are some payer limitations on how early you can submit credentialing paperwork for a provider – start the process as early as possible. Oftentimes 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.
Review the information you have obtained from the provider and scrutinize everything
There are no long-term commitments for Med USA’s Credentialing Services and pricing is usually done on a simple to understand per application or per task basis. Contact Us at firstname.lastname@example.org or 801.352.9500 Option 4 to learn more about our customized credentialing solutions.