Provider Credentialing Services

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Provider Credentialing Services 1

CREDENTIALING SERVICES CREDENTIALING REDCREDENTIALING PRIVLEGIES APPLICATION MANAGEMENT PROVIDER ENROLLEMENT SERVICES

INTRODUCTION

The credentialing process for a doctor’s office, provider network or hospital is can be one of the most expensive budget items. Med Advantage had been working diligently to expedite the process and reduce the cost to credential a provider through automation, large datacenter and more importantly proprietary process & software.

CREDENTIALING/ RECREDENTIALING Med Advantage has developed and actively maintains a proprietary database containing verified records of over 970,000 individual healthcare Providers who have been credentialed by the Company at least once (actual transactions are over 1.8 Million) as well as a data warehouse which links together 98 primary data sources and contains information on over one million healthcare Providers. The data warehouse is used to update existing records in the Company’s database as well as to provide and verify information for a Provider that is added to the database.

The database includes Providers in all 50 states, the District of Columbia and the Commonwealth of Puerto Rico. The Company’s size combined with its data management and verification capabilities make Med Advantage one of the three leading companies in the CVO industry and the only one that is independently owned. It is positioned to become the single point of credentialing whether to the Payor community or to the providers themselves.

In this regard, the maintenance of a database and data warehouse not only enables Med Advantage to perform provider enrollment and CVO services faster and more accurately than substantially all of its competitors and healthcare organizations who credential in-house, but also provides the company with a cost advantage. Med Advantage was founded in 1993 and is headquartered in Orlando, FL.

Credentialing involves the verification through primary source data of a variety of healthcare Provider information, including, but not limited to: license, hospital privileges, DEA certificate, Board certification, residency, medical school, malpractice policy, claims history, National Practitioner Data Bank, Federation of State Medical Boards, sanctions against licensure, Medicare/Medicaid sanctions and ongoing monitoring of sanctions.

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PRIVLEGIES Privileging for a hospital involves understand the risk associated with the staff admissions process and includes verification of license, other hospital delineation of privileges, DEA certificate, Board certification, residency, medical school, malpractice policy, claims history, National Practitioner Data Bank, Federation of State Medical Boards, sanctions against licensure, Medicare/Medicaid sanctions, references work history, compliancy and ability to perform services with in a department and ongoing monitoring of documents & sanctions.

APPLICATION MANAGEMENT A Company credentialing process begins with a request for credentialing or re-credentialing of a specific Provider or group of Providers. As part of the request, the client/plan may require the use of CAQH, a State mandated application or a company specific that Med Advantage can populate provider data pulled from the database so the enrollment/credentialing transaction can be performed with in ease.

Med Advantage’s proprietary credentialing system then automatically converts such data into a usable format and matches the data with the information in the data warehouse. The matched data is then merged into the Company’s database to begin the application process. Data extract requests are an efficient way to credential large numbers of providers with minimal administrative effort which helps in the production and the price for the client. The application utilized is generally Med Advantage’s comprehensive application or a state specific mandated application. In order to provide clients with maximum flexibility, credentialing application requests can be setup in one of three ways: State Mandated application, Med Advantage’s universal application and using the client specific application.

PROVIDER ENROLLEMENT SERVICES

Whether your practice or network is made up of one specialty or several, you’re already familiar with the sometimes mountain of paperwork involved in maintaining existing privileging, provider/payor relationships and forging new ones.

The average healthcare provider contracts with anywhere from 15 to 30 payors, and the appropriate applications or forms need to be requested, credentialing information needs to be gathered, the applications—which can stretch as long as 50 or more pages—need to be filled out by hand, the signed paperwork needs to be submitted, followed up on, then continually kept up with in terms of updating and re-attesting.

Right now, an office manager or other staff member within your practice may be struggling to juggle provider enrollment in addition to their primary job duties, trying to make sense of application after application, scrambling to ensure each provider is able to see as many patients as possible and receive accurate and timely reimbursements. Or perhaps your practice offloads the responsibility to a billing vendor whose specialties do not include provider enrollment. Despite their best efforts, could they be missing something? Wasting valuable time, money and resources?

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If a provider who is beginning work at a practice location or facility is not enrolled in the correct plans and networks, he or she will not be able to see patients that utilize that insurance or healthcare plan, resulting in money lost. Since provider enrollment is directly linked to revenue, it’s important to rely on experts to be sure nothing slips through the cracks.

Med Advantage Provider Enrollment Services is the answer! Quickly and easily submit your credentialing documentation to Med Advantage only once and we’ll keep it on file to enroll you in the networks of your choosing. Let us deal with the steady stream of paperwork so you can maintain focus on patient care. We will save your practice countless hours completing multiple, lengthy applications by hand as well as calling and emailing to follow up on these applications.

Services include:

• Create or Maintain CAQH UDP • Confirm participation in Medicare & Medicaid plans • Set up the provider in the Med Advantage database • Identify all the plans, payors and Hospitals required for ongoing monitoring. • Initiate credentialing or recredentialing processes • Follow up in order to gain participation ID • Follow up on denials and appeals • Identify new plans or Hospitals to target • Update plans required documents and expirables

DIFFERENCES While there are many originations that offer the services of Credentialing & Provider Enrollment services none offer the experienced offer both, the primary reason Med Advantage stands alone, however other reasons include:

• 22+ year experience, • 1.8 Million Application transactions, • Over 1 Million providers • National accreditation with URAC & NCQA • Profiling Primary Source Verified data • 3000+ unique documents & applications • 97% of all MD & DO in the nation are in our database • Full services CVO credentialing • Network recruiting • Provider reimbursement evaluations • Full web based reporting

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REPORTING Med Advantage uses web services for easy reporting, keeping you updated is the highest priority. Following are some sample web reports:

PRICING Med Advantage offers these traditional services with the understanding that services is the number one concern and in three different options: Standard, Full services and White labeled or wholesale. The services differ based on the level of services and the number of plans you belong or want to belong to.