INSURANCE CREDENTIALING SERVICES
Whether you’re a private practice or larger healthcare facility, insurance credentialing is the first and most important step in implementing your new revenue cycle. Yet, even when you know which insurance companies you want to participate with, getting credentialled is a time-consuming and often frustrating process. That’s why many healthcare organizations outsource this crucial step.
Maxx Healthcare wants to be your Practice Management Concierge service. We handle insurance credentialing for physicians, hospitals and a wide variety of other healthcare institutions. From start to finish, we will walk you through each step of getting approved with an insurance payor. Learn why countless healthcare professionals and organizations entrust us for medical insurance credentialing services.
CREDENTIALING WITH INSURANCE NETWORKS
In today’s healthcare marketplace, the ability to accept potential patients’ insurance plans is essential for your practice’s success. Health insurance credentialing, also called provider insurance credentialing, is a process that medical insurance companies use so that you can apply for inclusion in their provider panels. If you wish to bill an insurance company as an in-network provider, you must undergo the credentialing process.
First, the insurance company you’re applying to will verify that you meet their internal requirements so that you can serve as an in-network provider on their panel. This could include your level of education, training and professional experience.
Once your practice or organization is credentialed with an insurance company, you can bill the payor directly. Also, many insurance companies offer providers other incentives, such as:
- Referrals.
- Preferential reimbursement rates.
- Inclusion in their web-based directories so consumers can locate you as a participating provider for your specific specialty.
With Maxx Healthcare, we help you get your applications completed twice as fast for Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, TRICARE and almost any other provider. Below are just a few functions we perform on your behalf throughout the credentialing process.
NETWORK RESEARCH
We make sure your Practice or Group has the most varied, popular and effective in-network payor mix.
Our credentialing team has extensive experience in enrolling physicians with Medicare, all Medicaid’s Managed Care plans along with all commercial payors. Our team reaches out to each shortlisted payor that you want to enroll with and gets accurate timelines and open panel availability.
APPLICATION FILING
We send you a complete checklist of all the information and documents that are required to file the applications.
As soon as we have the details from you, our Enrollment team goes ahead and files the appropriate contract applications and makes sure it’s a flawless submission in the first go, owed to our extensive experience. As a result of our first-time correct application submissions, we proudly boast of the shortest turnaround time in getting the contract.
APPLICATION FOLLOW UP
Our team follows up on the submitted application every two weeks, to ensure that the submitted application has been received.
We follow-up regularly until the contract comes through and is delivered to your physical location.
APPEALS FOR CLOSED PANELS
Payors like UHC, Aetna and BCBS sometimes have closed panels for Labs for a particular area. We make sure to send an extensive.
Appeal outlining the key points of your service, including niche services and details on how you bring exceptional patient care in your area. All these details are included in your business plan and submitted to senior provider representatives at that payor. While it can be difficult to overturn the closed panel decisions, we have a 30% success rate.
OUT OF NETWORK ENROLLMENTS
This is for all providers who choose to stay out of network with certain payors. Or if due to any closed panels, are forced to stay, out of network. Our team helps with out of network enrollments, NPI registrations on the payor’s website etc. so that your medical practice is in the payor’s system to start receiving out of network payments.
DEMOGRAPHIC CHANGES
We help with all basic and complex demographic changes such as updating a new TAX ID with all payors in your payor mix, updating a new address, bank account, etc. We also help set up all ERA and EFT enrollments.
ANNUAL CREDENTIALING MAINTENANCE
For larger healthcare facilities with multiple providers, accurate provider database management is pivotal. We manage and maintain all your providers’ and physicians’ credentialing data on our credentialing portal. It’s a very comprehensive, transparent and HIPAA compliant tool that we specifically designed to make sure we upkeep your database with the utmost efficiency and accuracy.
PECOS AND CAQH SET UP AND MAINTENANCE
Keeping up to date PECOS and CAQH profiles is of utmost necessity in today’s healthcare environment.
The biggest payors are all turning the CAQH route to credential and enroll medical providers. We maintain and upkeep your CAQH and PECOS profiles, making sure all your information is accurately profiled and compliant.
CONTRACT NEGOTIATIONS
We not only get you the contracts, but we do fee rate negotiations for you as well. We have an extensive database of all payors’ latest fee schedules. We study your competition and this data helps us to make sure we get you the best possible rates for your procedures, thus solidifying optimum reimbursements for your medical practice. We revisit your older contracts and try and get better rates as per availability from the payor at the current time.
