Contracting and Credentialing Support
Renegotiating a Payer Contract?
Feel like you’re always knocking on the payers' doors and no one ever answers? Our contracting team has tons of experience on both sides of the table.
We Improve Contract Management and Negotiation
Payer contracting is a multifaceted strategic endeavor in today's healthcare environment. It impacts every aspect of your group's business strategy and even drives your clinical strategies. Contract Negotiation is the foundation for all your reimbursements.
We've spent years working on both sides of the table. We know how to negotiate reimbursements on your behalf.
You need to take a new approach in order to negotiate payer contracts effectively in the post-healthcare reform environment.
Value Based Contracts
When your practice can prove that you deliver better care, insurers should be willing to provide better reimbursements. Value based contracting ensures that your insurance contracts reimburse for the quality of care you deliver.
Contract Monitoring & Enforcement
Too often payers aren’t as diligent about keeping up their end of the contract as they are about making sure you keep up yours.
Insurances companies are notoriously unresponsive to small urgent care and emergency medicine groups. It almost seems like they depend on the fact you have neither the time nor the inside knowledge it takes to make certain payers are diligently keeping to their commitments to your practice.
That’s why we have a tenacious contract monitoring process here at ConsensioHealth. We keep close watch on our clients' insurance contracts using procedures developed with, and honed by, knowledge gained from years of experience gained on the inside. We’ll help your small practice keep a fair and equitable position.
What is Physician Credentialing?
Credentialing is also referred to as payer enrollment. It's the first step of, and the foundation for, all your interactions with government and private payers. It's the process insurance companies employ to verify your physician’s licenses, education, background, and other information. During the credentialing process, they'll also create the contract that sets the reimbursement rates and rules of billing.
Insurance providers may enter or leave your service area and hopefully you'll be hiring new physicians and other practitioners as your emergency medicine group grows or as you open new urgent care clinics. You’ll need to maintain the on-going capability to conduct credentialing, unless ConsensioHealth establishes payer contracts for you.
We offer our best credentialing service as an integrated part of our coding and billing service. We verify contract status, collate your payer contracts, and obtain full fee schedules for each payer.
We Document Newly Hired Provider Credentials
Credentialing is a long-winded and confusing process to most. This is why ConsensioHealth answers all your questions about the process. We’re here to:
- Verify license, certification, Drug Enforcement Agency ID, and National Provider Identification (NPI).
- Assist newly licensed clinicians acquire their NPI.
- Collect and securely maintain supporting documents (e.g. driver’s license, birth certificate, Social Security number, diploma, and curriculm vitea) needed for credentialing applications.
We Submit Credentials and Applications
You need a separate application packet for each and every one of the government and commercial insurance carriers. We'll compile the correct materials and submit applications on your behalf:
- Medicare and Medicaid
- Insurance companies, e.g. UHC, Anthem, Humana, et al.
We Follow Up With Insurance Carriers
Insurance carriers aren't always diligent about following-up. In order to keep your applications on track, we'll:
- Verify receipt of applications
- Respond to additional information requests
- Track application processing to ensure timely approval
We Confirm and Maintain Credential Approvals
Of course, once is never enough. The whole tedious process of credential approval needs to be repeated on a regular basis:
- Confirm you approvals in a timely manner
- Maintain a provider file with credentialing approval documents
- Track re-credentialing requirements of insurance carriers
- Re-credential on provider’s behalf, as needed
We Troubleshoot Insurance Non-Payments
Credentialing issues inevitably arise, so we keep close communication open with insurance carriers to ensure correct provider payment.
Enrollment with your payers does take time. The sooner you start credentialing, the sooner your new hires will start contributing to your group's success.