Medical Credentialing & Contract Negotiation

Medical Credentialing

As any healthcare professional is aware, medical credentialing is a complicated and tedious process whether you are a solo-practice or a practice with several physicians. Connecting with the correct insurance company employee responsible for the credentialing process can be an entire process on its own. Even after you establish that connection, completing the necessary paperwork accurately can take seemingly endless hours or even weeks. Our streamlined credentialing services remove the challenges of decreased administrative time and the costs with pursuing credentialing tasks by your staff. Because it is such a detailed process, our expertise ensures that redundant or missed important details don’t occur. We handle credentialing for practices of any size and we can provide this service in all 50 states.

Your number one priority is spending time with patients, not worrying about filling out paperwork.

  • Spend time with patients, not filling out paperwork – Your staff are free to spend time on more important issues
  • We work with; physicians, Pas/NPs, Hospitals, PT/OT/SP, Podiatrists, Chiropractors, Laboratories, Sleep Labs, Dentists, Orthodontists, Optometrists, Ambulatory Surgery Centers, Audiologists, Rehab Facilities, and many more
  • Physician Credentialing and Enrollment Services we can help with;  Medicare, Medicaid Provider Enrollment,  Revalidation and Credentialing, PECOs, CAQH Registration, NPI Registration, Type I and Type II, Managed Care Contracting Issues, Reimbursement Issues.

Why Use Us

  • Increase Patient Referrals
  • Get Paid quicker by insurance companies
  • No paperwork and endless applications on your part
  • Initial contracts and applications are completed correctly from the onset, therefore time saved and no delays in payments
  • Access to your status and documents which are maintained on a secured database
  • We are experienced to get you credentialed with correct insurance payors accurately and timely

 

Contract Negotiation

Does the thought of sitting through contract negotiations with health insurance providers mentally exhaust you? Our experts in contract negotiation are able to connect with the correct insurance carrier employees to negotiate the best terms and conditions for your practice. We take into consideration the volume, current industry reimbursements for the demographic in your geographic area, and consideration for the market needs.

With insurance companies oftentimes being in the “power” seat during these negotiations, we keep our client’s best interest in mind. We scrutinize nuances such as fee schedules and confusing provisions. For example, we recommend our clients make sure their contracts include a look-back provision to ensure they can amend claims even after they’ve been submitted. We also watch for the distribution of CPT code reimbursements. Health insurance companies may reimburse a very high percentage on certain CPT codes, however they are ones your practice rarely uses. On the same token, they will offer low reimbursements on the CPT codes your practice frequently uses. For a more in depth conversation on how we can maximize your reimbursements from insurance companies, contact us.