Credentialing and Contracting

1. Verification that all required licenses are up to date.

    a. Medical license

    b. DEA

    c. NPI

    d. Medical malpractice

    e. Other certificates

2. Creating CAQH,

3. Creating login information for all required websites,

    a. PECOS

    b. Availity

    c. Individual insurance websites 

    d. One Inc

4. Create and apply for credentialing for up to ten insurance companies. More can be added to the package.

5. Communication with the practice/provider weekly to update on credentialing progress.

1. Maintenance of  CAQH.
2. Verification of required license each year with notification before expiration dates.
3. Update governmental credentialing as required.
4. Update and maintain commercial insurance.
5. Malpractice verification.
6. Hospital credentialing as required by the client.

This is designed to support managers and billers who encounter difficulties in obtaining specific insurance credentialing.

It also applies to situations where providers are not receiving claim payments, despite having completed the credentialing process. 

Request contracts for individuals or groups.

Review the contract for language issues and prepare an easy-to-read spreadsheet of the most common areas providers need. 

Prepare a spreadsheet outlining the proposed fee schedule's effects on the provider or practice. Assist with negotiating the fee schedule.