the most effective solution for credentialing management
A-Z credentialing and enrollment service
manage your patients not your contracts
Managing credentialing files for payers and facilities sucks up precious time from your staff, diverting their focus aware from patient facing activities. Our managed credentialing service lets you refocus those payroll hours to activities that impact the value of care your patients receive.
With more than three decades of revenue cycle and Credentialing management, our expert team can have you onboarded in as little as 24 hours. Our custom solution ensures that all of your contracts are meticulously managed, and our secure portal ensures that your information stays secure.
services we provide
Continuous Management
Payor Mix & Viability Analysis
Provider/Group Enrollment Assessments
Medicare/Medicaid Enrollments
CAQH Maintenance
Demographic Update Management
Out-of-State/Regional Payor Enrollments
Initial Hire Onboarding
Facility Credentialing Management
managed update notifications so your files are never out of date
New provider onboarding can be one of the most stressful activities a practice can take on, and we’re here to ease that burden by off-loading your credentialing and contracting tasks. Our dedicated team can guide you through information collection and application preparation for any payer, network, or facility. Our process ensures a limited amount of clarification requests and delays, and our always up-to-date status matrix keeps you informed on progress at all times.
The old rule of thumb was 90 days for credentialing, and while still true in some cases, as requirements expand to encompass non-physician providers it can now take up to 6 months. Many practices make the mistake of focusing on faster payers first, causing this process to take even longer. We work with you to identify what payers you should contract and what submission priority will allow for the fastest timeline and, with our fast-start process, your providers could be seeing patients in as little as one week.
Our Fast-Start process can have your providers seeing patients in as little as one week!
Our proactive approach keeps your applications from being unnecessarily rejected. We scrutinize every detail large and small:
- Verify form & application version
- Verify submission requirements
- Manage support document layouts
- Ensure up-to-date support documents
- Update CVs and provide guidance on detailing gaps in time
- Ensure professional use of color*
*Even petty “mistakes” can be enough to cause application failure. Reminiscent of payer denials in the 90’s from using photocopied HCFA 1500 forms.
who we work with
Ambulance
ASC
Anesthesiologists
Behavioral Health
Dentists
Dermatologists
Emergency Medicine
Family Practice
Gastroenterology
Hospitalists
Internal Medicine
LSCSW
Neurologists
Nephrologists
OBGYN
Occupational Medicine
Ophthalmologists
Orthopedic Surgeons
Pediatrics
Physical Medicine
Podiatrists
Radiologists
Therapists
Sports Medicine
Urgent Care
Urologists
And many more!
$2.1 Billion is lost annually to outdated provider data
Since 2016, it has been mandated that all Healthcare.gov and Medicare Advantage plans update their provider demographics once per 90 days, and still nearly every practice in the U.S. has at least one provider with outdated credentialing files. By not keeping up this data:
- Patients seek care from out-of-network providers unknowingly, leading to higher than expected bills
- Payer tools to assist patients with locating a doctor end up showing physicians no longer practicing or that have completely left the region
- Providers experience unnecessary billing and administrative complications, leading to poor RCM performance
- Providers may not get timely notifications for update requests or contract amendments, which could lead to termination or unfavorable payment rates
The typical update can take as long as 10 minutes per provider per plan. Considering that most providers have north of 20 contracts, this adds an additional 2 days worth of administrative burden for the typical 2-5 provider practice. Per quarter! Easy to see why compliance is so low.
What could you do with an extra 6 days per year?
Offload this time costing activity from your support staff and drive up the quality of data reported by handing this task off to our service. Once per quarter, our staff will manage all demographic update requests for all payers, networks, and facilities; including submitting updated medical licenses, malpractice verification, and general liability declarations.
Better yet, we will work with your RCM staff or solution to ensure that all available payers have been set up for EDI transactions. Allowing for e-verification of eligibility, claims transmission and status, and payments; leading to cleaner claims and faster payments.
Ben Marcus Consulting 