credentialing Health care organizations

 We use CAQH, the healthcare industry's premier resource of payers, hospitals, large provider groups, labs, and health systems credentialing and enrollment solution.     

Technology Solution:  

Shared utilities to collect and manage provider and member data. 

1. CAQH ProView® is the industry standard for provider data collection and distribution.
2. VeriFideTM streamlines credentialing by standardizing and automating PSV. 
3. SanctionsTrack® delivers comprehensive, multi-state information on provider licensure disciplinary actions.

List of Services: 

CONTRACTS AND COMPLIANCE - We help your practices maintain paperwork compliant with standards. 

CONTRACTING AND CREDENTIALING - By setting up contracts to submitting application forms to insurance companies, our dedicated team will help you get credentialed with insurance. 

We also will identify top carriers based on location and the type of services you provide and start the credentialing process for you. This ensures predictability and profitability from day one.

• INITIAL STATE MEDICAL LICENSING - Our team completes the entire licensing process in all 50 states on your behalf.
• ANNUAL CREDENTIALING MAINTENANCE - Provider license renewal - For healthcare facilities with multiple providers, accurate provider database management is pivotal.
• NPI REGISTRATION - We will get your National Practitioner Identifier registered.
• LICENSURE MAINTENANCE - We will monitor your license, notify you and get it renewed automatically.
• OON ENROLLMENTS -  (PCG) provides out-of-network (OON) enrollment services to providers who choose to stay out of network with specific payers or are forced to stay out of network due to closed panels. Our team helps with out-of-network enrollments, NPI registrations on the payer's website, etc., so your Lab is listed in the payer's system to start receiving out-of-network payments.  
• TRAINING LICENSE -  for Residents' Internship, Fellowship, or graduate medical program. We will obtain the training licenses.
• FCVS SET-UP and RETRIEVAL - We will complete or retrieve your FCVS profile and send it to the Medical Board of need.
• DEA/CSR REGISTRATION -Our experienced team will obtain your CSR and DEA licenses in any state.
• PAYER ENROLLMENT - Medicare and Medicaid Provider Enrollment and revalidation - Are worked timely to avoid past timely filing denials. 
• COMMERICAL INSURANCE  -  Provider enrollment and re-credentialing. We follow the insurance schedule for re-credentialing (and PCG) and will complete the enrollment process with all commercial payors.
• APPEALS FOR CLOSED PANELS -  Global contracts with Third Party Administrators (TPAs). We coordinate and negotiate with Third Party Administrators on setting global contracts for the services provided. 
• APPLICATION FOLLOW-UP - Our team follows up on the submitted application daily to ensure that the application has been received.
• CONTRACT NEGOTIATIONS -We negotiate fee rates for your current and new contracts. We maintain an extensive database of the latest fee schedules for all payers.
• CAQH REGISTRATION, MAINTENANCE, AND ATTESTATION - Our team will establish and keep your CAQH profile active.
• PECOS SET-UP AND MAINTENANCE - Maintaining up-to-date PECOS and CAQH profiles is critical. We ensure proper maintenance of your CAQH and PECOS profiles, guaranteeing that all your information is accurately profiled and compliant. Physicians update and re-attest their CAQH profile annually. We consult, send reminders, and maintain the database. 

RED FLAGS IN CREDENTIALING: 

Credentialing often reveals many things about a healthcare professional's past. While some may be benign events, many healthcare professionals who apply for credentialing come with questionable papers and inadequate clinical experience. Some of the warning signs we look for include the following:

• The reluctance of the applicant to provide permission to contact the previous employer or healthcare institution
• The reluctance of the application to provide specific references or perhaps the references are too vague
• Sudden relinquishment of licensure or medical staff membership
• Sudden loss of privileges in a hospital
• Marked gaps in clinical practice
• Short tenure at multiple hospitals
• An unusually high number of professional liability actions with the final judgment against the practitioner
• History reveals substance abuse, domestic violence, or unprofessional conduct.
• History of being investigated by the state board of licensure or other healthcare organizations
• Significant gaps in insurance coverage
• Evidence of poor program evaluations more than once