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 get 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 make 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 and is in the payor’s system and that no additional information is being requested and everything is smooth. 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.
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.