INSURANCE CREDENTIALING SERVICES
Whether you manage a small private practise or a large healthcare facility, gaining insurer credentialing is the first and most important step in setting up your new revenue cycle. Even if you already know which insurance firms you want to partner with, gaining credentials is a time-consuming and frequently tough process. Many healthcare organisations outsource this crucial phase for this reason.
Your go-to source for practise management information is Medz Healthcare. For hospitals, medical practises, and several other healthcare groups, we oversee insurance credentialing. We will walk you through every step of getting approval from an insurance payer, from start to finish. Learn why many healthcare organisations and professionals entrust us with their requirements for medical insurance certification.
CREDENTIALING WITH INSURANCE NETWORKS
In the present healthcare market, your ability to accept potential patients’ insurance coverage will determine how successful your practise is. Health insurance credentialing, also known as provider insurance credentialing, is a process used by medical insurance companies to allow you to apply to be included in their provider panels. If you wish to be billed as an in-network provider by an insurance company, you must go through the credentialing process.
You must first prove that you match the organization’s internal criteria in order to be accepted onto the insurance company’s panel as an in-network provider. Your degree of education, training, and work experience might be taken into account.
NETWORK RESEARCH
We make sure that your Practise or Group has the most diverse, popular, and prosperous in-network payor mix possible.
Our credentialing team has years of experience signing up doctors for Medicare, Medicaid Managed Care Plans, and private payors. Our team gets in touch with each payor on the shortlist that you want to enrol with in order to confirm exact deadlines and open panel availability.
APPLICATION FILING
A detailed list of all the information and materials required to submit the applications will be sent to you.
Our enrollment staff instantly starts completing the necessary contract applications as soon as we receive the information from you due to our extensive knowledge, and we make sure that it is a flawless submission on the first try. As a result of accurately submitting our applications the first time, we can certainly assert that we had the quickest turnaround time for securing the contract.
APPLICATION FOLLOW UP
A member of our team follows up on the submitted application to make sure it was received every two weeks.
We follow up periodically until the contract is delivered to your actual address.
APPEALS FOR CLOSED PANELS
Closed lab panels for a certain area are periodically offered by payors including UHC, Aetna, and BCBS. We pledge to give a thorough message.
appeal outlining the core characteristics of your service, any specialty offers, and details on how you deliver the finest patient care in your area. All of these details are included in your business strategy, which is presented to senior provider representatives at that payer. Despite the difficulty, we have a 30% success rate in reversing decisions made by closed panels.
OUT OF NETWORK ENROLLMENTS
This is applicable to all providers who choose not to take part in certain payor networks. Or if any closed panels need them to stay outside the network. Our staff helps with NPI registrations on the payor’s website, out of network enrollments, and other tasks so that your medical practise can be registered in the payor’s system and start earning out of network payments.
DEMOGRAPHIC CHANGES
All simple and complex demographic changes, such as updating a new TAX ID with all of the payors in your payor mix, a new residence, a bank account, etc., are assisted by us. Additionally, we enable complete setup for ERA and EFT enrollment.
ANNUAL CREDENTIALING MAINTENANCE
For larger healthcare facilities that contain numerous doctors, accurate provider database administration is crucial. We maintain and manage all of your providers’ and doctors’ credentials information through our credentialing portal. This complete, open-book, HIPAA-compliant tool was developed by us to make sure that we maintain your database as precisely and effectively as we can.
CONTRACT NEGOTIATIONS
We not only secure the contracts for you, but we also negotiate price rates. Our extensive database contains the most latest charge schedules for all payors. In order to guarantee that we acquire the lowest pricing for your operations and the maximum possible reimbursements for your medical practise, we thoroughly research your competitors. We examine your prior contracts and make an effort to improve conditions with the payor depending on the payor’s current availability.