We provide consulting services for credentialing process:
- Providers to create standards to meet NCQA and URAC guidelines
- Create and update credentialing policies annually
- Help facilities prepare for pre-delegated and delegated credentialing audits
- Prepare for Health Plan audits
- Prepare URAC Training for staff members
- Prepare NCQA Training for staff members
- Provide solutions how to get contracted and credentialed with all health plan carriers
- Solutions for maintaining credentialing and re-credentialing status
- Solutions for ongoing monitoring on practitioners for screening sanctions and compliance
CLAIMS FOR MEDICAL SERCICES WILL DENY OR GET DELAYED IF PROVIDERS ARE NOT CREDENTIALED !!
Credentialing is an important part of the revenue cycle management and impacts your return on Investment (ROI) for your providers and practitioners within your practice.
Many payors require practitioners to be credentialed prior to treating health plan members.
We consult providers and facilities on the importance of maintaining credentialing on an ongoing basis.
Credentialing process takes up to 60-90 days with some payers, so please make sure to plan for this when hiring new providers to your practice or opening up a new location.
Contact us to help with your credentialing management structure.
5 Key Tips to remember for Credentialing:
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Start Early at least 120 days prior to treating patients
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Be detailed and complete application with required paperwork accurately to avoid delay
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Consistency is key to follow up with payors to check status of your applications
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Important to receive credentialing approval letter prior to treating patients, otherwise claims will deny
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Stay organized and Do not forget to Recredential every 3 years