Enrollment & Contract Negotiations

“We do all of the work to eliminate the headaches for you so that you can focus on practicing medicine”

CAQH- Enrollment and Updates

The CAQH Universal Provider Datasource (UPD) is setting the industry standard for provider data collection. UPD is achieving its vision of simplified credentialing by reducing paperwork and millions of dollars of annual administrative costs for more than 700,000 providers and 500 health plans, hospitals and MCOs across the United States. We can help you to obtain your CAQH ID and in completing your online profile. Having a complete CAHQ profile is an important step in commercial insurance credentialing. We know CAHQ ID can be confusing and can take up a lot of your time. We are always here to help you and will make this process as easy as it can be for you.

Obtain NPI for New Groups and Update Existing Ones

The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. Providers are strongly encouraged to obtain an NPI if they have not done so already. Our practice management system has your NPI implemented for use on electronic claims for you. If you need help obtaining this information or if you need to update an existing one, our team is here to assist you in completing this task.

Group and Individual Provider Contract Negotiations

Negotiating a contract with a health plan can often be time-consuming and labor intensive. It usually leads physicians feeling frustrated and uninformed. The contracting process is unfortunately structured to put the physician at a distinct disadvantage. As a result of this practices must be willing to invest substantial time and efforts in trying to ensure a successful negotiation and to secure a mutually favorable contract. We take the stress out of this process for you. With our knowledge and the ability to identify your leverage, we will not only get your practice the best contract negotiations as possible, but we will put your mind at ease knowing this daunting task is being handled by our experienced professionals.

Group and Individual Provider Enrollment

Whether you are a private practice or a multi-specialty group our team of experts will help you expand your business or start you off on the right foot. The demands put on medical practices to achieve clinical excellence and patient satisfaction while meeting financial and operational demands require more work than ever before. Setting up your practices credentials can be a huge burden for you and your staff. We specialize in all major Payors including medicare and medicaid, within any state.

Re-Credential Providers as needed in Various Health Plans

Being a provider you already know the how beneficial it is to be on a variety of insurance panels. You are able to build you client volume and not have to turn away new clients because you don’t accept an insurance carrier. When the time comes to re-credential a specific health plan it can be a daunting task that you or your staff may not have time for. This could result in a loss of clients, claims not being paid or even being locked out of a health plan. We want to make sure that you are on top of this process before any loss of enrollment occurs.

Utilize Credentialing Software

Using software allows us to deliver optimal results for your practice. All the tools are at our hands to help maintain licensure, malpractice and other documents needed to facilitate the credentialing process. Some of the benefits by using software is reducing provider enrollment turnaround time, accelerate reimbursements, reduce errors, eliminate missed deadlines and avoid payment delays. Which means a faster and more accurate service for your practice.

Follow Up on Claims as it Relates to Enrollment

Practices that don’t follow up on claims usually result in financial losses. There are a lot of things that can be done to prevent delays in claim processing and in some cases higher reimbursements. Claim follow up leads to consistent outcomes in your efforts to collect revenue.

Servies:

  • Practice benchmarking
  • Provider enrollment
  • Re-Credentialing
  • Credentialing servicing
  • NPI Acquisition
  • Group enrollment
  • Contract negotiations
  • CAQH enrollment and updates
  • Credentialing software utilization
  • Claim follow up
  • HIPAA compliant staff
  • Payment posting
  • Claim submission and tracking
  • Denials and appeals
  • Patient statements and payment plans