Medical Credentialing (On-Board Process for Providers, Facilities)

Credentialing for providers, large groups, or facilities can be a tedious task that can often require a team of specialists to handle all the on-boarding information as well as updates throughout the ...

Credentialing for providers, large groups, or facilities can be a tedious task that can often require a team of specialists to handle all the on-boarding information as well as updates throughout the year. As of April, 2018, CMS now mandates that providers maintain accurate information and timely updates. Providers and facilities that do not keep up with these updates risk having their in-network status with the insurance company taken away as well as fines and penalties.

We have composed some of the most popular questions and concerns that your office may have in choosing someone to credential your providers.

Questions:

Turn-around time – 24 hours

New Provider – Using primary source verification, we are able to pull most of your provider’s information within a few hours. If more information is needed from the provider or facility then we can gather that information quickly by sending you a secure link with information needed to send back.

Resolve a credentialing issue – Our credentialing applications are tailored to the insurance companies specifications. If there is wrong information or information missing then the application cannot be sent out without it being corrected. The turnaround time would be same day for us. If there was information lacking from the provider then they would get a same day email with information needed and a secure link to add the information.

How to send and receive applications and required documents

Most of the information will be gathered via primary source verification. This is the most up to date accurate information that can be populated. In most cases it has more up to date information than what the provider has available to give us. All applications will be generated electronically and able to be signed electronically.

Availability for participation in our on-boarding meetings

We are available 5 days a week. Monday through Friday and Saturday mornings for any conference calls. We would be happy to accommodate your requests.

What distinguishes us from our competitors?

Primary source verification: we are alerted to any changes in the providers license, credentialing, DEA, CAQH, NPPES etc., the same day it is changed in their systems. This is usually weeks before the facility or provider is even aware anything has changed. This allows us to alert you and the provider of any credentialing, licensing, certifications, and board expiration’s that come up in a timely manner so we can correct them and keep your providers and facility in full compliance.

We are able to tailor credentialing applications to the insurance companies specifications so that there is little to no denials.

We have electronic signature capabilities on all credentialing applications that can be sent directly to the provider through secure email. We are also able to provide each on-boarded provider with their own credentialing secure email if your facility would like.

Most everything that we do is electronic, which will eliminate most, if not all, need for paper forms or paper signature requests.

Provider /Facility and its managing employees would have access to our secure software platform for you to view and print any and all provider information, licenses etc., that you may need to keep on file.

We can provide you reporting on when applications have been sent, viewed by the provider, signed by the provider, accepted by the insurance company. We keep track of every email, signature, view, acceptance, denial, and more. All communication is auto-documented and made available for you and your staff to see. Transparency and communication are very important to us.

We are able to integrate with CAQH so there are timely automatic updates as soon as the primary source verification has also been updated.

We are available to speak with you 6 days a week.

Timeline to provide services from date contract is signed

(Once a contract to provider credentialing services to your facility and providers was signed and the Excel spreadsheet was sent over with the providers information, the timeline would be as follows):

Providers would be complete and added to our software within 5-8 business days.

By week two you can expect the providers to be integrated with primary source verification, CAQH, NPPES, PECOS, DEA, and other licensing agencies.

By week three, the credentialing contracts would be generated based on information you provide to us. E-mails would be sent to providers if more information was needed.

By week four, we would like to see everything submitted and sent out electronically.

While we strive to keep within our timelines, we are also at the mercy of the providers responding back to us in a timely manner as well.

After the first month, we would now be considered fully integrated and working on the current applications sent, maintaining provider compliance with insurance company(s), CAQH, NPPES, DEA, State Licensing.
Ready to add more providers as needed!