CredentialingSolutions for Complex Medical Business Management.
COMPMED’S CREDENTIALING PROCESS
Payments start with appropriate and timely credentialing.
Our credentialing staff ensures that all provider numbers are issued and that they are active at all times so as to prevent any delay or disruption in payments, and that revalidations and processed timely as well.
First and foremost, we make sure that we have all of the information we will need for initial enrollments and to maintain credentialing. We have an extensive check list to make sure we have the same information on each and every provider. We create a physical and electronic records of this data.
One of the advantages that CompMed has over other companies is that we obtain specific contacts with insurance company provider enrollment and credentialing departments. A very important part in credentialing is seeking out and developing a contact person for each payer we deal with and developing a relationship with that person. By doing this you are able to have a direct line to verify information that you send has been received and if a problem does arise, you have a specific person that you can go to. We have long-term relationships with these folks. Because the reps are familiar with us, we are very successful at getting problems resolved quickly.
We have a redundant credential expiration date notification system: 1) We automate renewal dates so that we are electronically alerted one month before an upcoming expiration date of a credential and 2) We set up a manual tickler system as a back up to ensure that we obtain and submit renewal copies of credentials. Our Credentialing Staff has direct contact with our providers so that we can obtain needed information on a timely basis, well in advance of a looming deadline/expiration date.
Our Credentialing Staff determines what specific enrollment information is needed from each payer in each State to make sure that we know what documents are required so that we can submit all enrollment forms and paperwork accurately the first time to avoid any delays in processing.
CAQH (Council for Affordable Quality Healthcare) is a major source in credentialing these days. We make sure the provider’s profile in the CAQH portal is up to date an accurate at all times. We work with each individual provider on both CAQH and PECOS (Provider Enrollment, Chain and Ownership System) so that we can make sure these sites are current and up-to-date at all times.
Medicare applications are completed online in PECOS for both initial enrollment and Revalidations. Again, we set up an electronic and manual tickler system to contact Medicare in advance of the Group Revalidation, because in late 2014, Medicare stopped sending out paper Revalidation request letters. This effort ensures that the PTAN (Provider Transaction Access Number or “provider number”) remains active and that claim processing or payments are not interrupted during the Revalidation interval.
We complete as many enrollments/re-credentialing online as possible. This ensures that the insurance company receives the requested information immediately, and more importantly, this method provides verification of receipt for us.
Our Credentialing Department has extensive successful credentialing and contracting experience with all type of payor types in over 30 states.
Commercial enrollments are processed in the same manner. We understand what the requirements are for each Payer and ensure that we obtain and submit the appropriate paperwork to enroll the provider/group and that all provider numbers are issued timely and remain active at all times.
Credentialing and enrollments directly with the Payor is just one facet of our process. Through our Clearinghouse, Change Healthcare, we use an online web portal to set up electronic claim and remit agreements. Most of these applications request the same information as the insurance provider enrollment departments do. This portal contains an electronic notification and verification system to ensure that submitted applications are processed and approved in a timely manner. This ensures that we submit as many claims electronically as we can and that in return, we receive payment data in the form of an ERA (Electronic Remittance Advice), which eliminates manual payment posting.
Another facet of our credentialing process is to set up payments to be received via EFT (Electronic Funds Transfer). We set up EFTs with every insurance company that offers this. This allows clients to receive their money electronically, which eliminates paper checks and paper EOBs (Explanation of Benefits) getting delayed or lost in the mail. Also, it assists us with electronic tracking and balancing of monies. Money gets posted faster, which ensures efficient and effective operation of the billing cycle.