Credentialing & Enrollment

Activating Revenue and Maximizing Efficiency

Decrease disruption to your revenue cycle leading to more success

Our team is equipped with the experience and technology to proactively and transparently manage the time consuming process of onboarding new clinicians, verifying credentials, and everything else. We focus on bridging the gaps between maintaining revenue and payments while collaborating with your team to maximize provider satisfaction.

Payer Verification

Enrollment Application Process

Delegated Credentialing Rosters

Re-credentialing

With the primary focus of healthcare organizations being on providing care, there leaves gaps in clearly understanding the payer verification process and requirements. Remaining up to date with the ever-changing payer policies along with there existing a lack of communication between payers and organizations, this multiple step process can be overwhelming for providers and organizations. By establishing clear communication with payers and putting systems in place to track and manage the process efficiently, we can help navigate the complex verification process by ensuring the following:

Updating information with payers
Preventing denials or delays by checking for errors
Consistent timely outreach to payers to obtain provider participation

An essential first step in gathering all necessary information to assess the qualifications of the provider or organization seeking to provide quality care. The problems with this process arise when documentation is insufficient and applicants are unresponsive to requests for additional information or clarification. Offering assistance to applicants, providing clear instructions and guidelines for completing the application process can lessen the burden. HCM can aid in implementing an accessible and standardized application process, mitigating any factors that could potentially cause delays or rejections to ease the stress by:

Preparing enrollment application requirements
Submitting application and following through completion
Enrolling providers with payers and TID number(s) based on service location(s)

Participating in delegated credentialing improves enrollment turnaround times and decreases staff workload; however, it can be challenging for organizations to comply with and meet the standards set into place by the organization in control of the delegated process. Organizations need a helping hand to manage risk, reduce liability, and ensure compliance with regulations. We can aid in faster enrollment and reimbursement while insuring a seamless delegated credentialing process for all parties by:

Managing each payer’s requirements to ensure compliance
Preparation and submission of rosters in accordance with each payer’s contract agreement
Maintaining accurate provider information details

The last thing care organizations need is to experience significant revenue loss as a result of denied or delayed claims made to the payer because of outdated provider information. Along with the potential financial burden, if provider qualifications and certifications are not verified or up to date, they cannot practice causing a decrease in the amount of quality care provided by organizations. The goal is to decrease the stress that comes with the complexities of re-credentialing leading to better care and improved outcomes. We can support and provide resources to ensure that organizations and staff maintain their credentials and licenses by:

Notifying providers of next expected re-credentialing date
Tracking credential expiration dates
Facilitating communication with accrediting bodies