Medical Credentialing & Enrollment Services
This includes:
● Healthcare administration consulting services to help you decide which panels to join in your area.
● Provider enrollment services for physicians and healthcare entities (non-participating and participating with health plans)
● Credential verification for physicians and ancillary healthcare providers
● Regularly follow-up and tracking status
● Network management for health plans
● Managed care contracting Medicare provider enrollment and revalidation services
Prior Authorization for treatment & Verification of Benefits
This includes:
● Verifying all necessary clinics are in the patient’s chart before beginning the process. Confirming
the patient’s current insurance ID# is up to date with the carrier (many expire or change).
● Verifying patient benefits for the services you will render (deductibles, co-insurance, etc).
● Verifying service is valid & billable as some codes are excluded or expired.
● Submitting authorization or pre-determination if required.
● Obtaining exceptions when available (only applies to out of network providers).
● If any of the above mentioned is denied, we will submit an appeal at no additional charge.
● There is NO CHARGE for any denied, not approved, non-covered cases.
Claims
This includes:
● Verifying correct documentation is in the patient chart for successful reimbursement of charges.
● Verifying the coding on the claim is correct.
● Submitting the claim
● Submitting clinics when/if required.
● Following up on the claim status.
● Appealing the claim if necessary.
● If a carrier is delinquent on processing a claim we will automatically file a Department of Insurance Complaint (to your state) at no additional charge.
● We do NOT charge to file a claim to the insurance carrier
● Once a claim has been paid we only then invoice our providers. This is based on the Actual check amount issued by the insurance carrier to your office or the patient. We do not invoice on the allowed amount, or applied to the deductible amount.