At Health Care Protectors, we adopt a meticulous and client-focused approach to provider credentialing:

Credentialing Application Management:

• Application Preparation: We prepare and submit credentialing applications for healthcare providers, ensuring that all required documentation is complete and accurate. This includes gathering necessary information such as education, training, licensure, certifications, and work history.
• Submission and Follow-Up: We submit credentialing applications to payers and follow up to ensure timely processing. Our team tracks the status of each application and communicates with payers to resolve any issues that may arise.
• Re-Credentialing: We manage the re-credentialing process for providers, ensuring that their credentials are kept current and compliant with payer requirements.

Primary Source Verification:

• Verification Process: We conduct primary source verification of providers’ credentials, including education, training, licensure, and certifications. This ensures that all information provided is accurate and meets industry standards.
• Compliance with Standards: Our verification process complies with industry standards, including those set by the National Committee for Quality Assurance (NCQA) and the Joint Commission.

Ongoing Monitoring and Updates:

• Continuous Monitoring: We continuously monitor providers’ credentials to ensure they remain in compliance with payer and regulatory requirements. This includes tracking expiration dates for licenses and certifications and ensuring timely renewals.
• Regular Updates: We update credentialing records regularly to reflect any changes in providers’ qualifications, such as new certifications or changes in licensure status.

Network Enrollment:

• Payer Enrollment: We manage the enrollment of providers with insurance payers, ensuring that they are credentialed with all necessary payers to maximize reimbursements. This includes Medicare, Medicaid, and commercial insurance plans.
• Contract Management: We handle contract negotiations and management with payers, ensuring that providers are enrolled under favorable terms and conditions.

Compliance Assurance:

• Regulatory Compliance: We ensure that all credentialing practices comply with regulatory requirements and payer guidelines. This minimizes the risk of penalties and fines associated with non-compliance.
• Documentation and Record-Keeping: We maintain accurate and complete documentation of all credentialing activities, ensuring that records are readily available for audits and inspections.

Reporting and Analytics:

• Detailed Reporting: We provide detailed reports on credentialing activities, including the status of applications, verification results, and compliance metrics. These reports offer valuable insights into the credentialing process and help identify areas for improvement.
• Analytics Tools: Utilize advanced analytics tools to track key performance indicators (KPIs) and identify trends in credentialing activities. This data-driven approach helps optimize the credentialing process and enhance compliance.