Provider Credentialing and Contract Review

Completing the arduous task of credentialing correctly and on time is the backbone of financially successful physician practices. Particularly, if you’re new to a practice, getting credentialed and contracted with insurance carriers can be a big barrier to entry. You cannot bill for services without proper credentialing/provider enrollment in place.

A typical credentialing application will ask for over 150 data points, requiring dedicated time to gather and submit information. Omitting data or making errors during the process can lead to delays or be grounds for denial. Excellent organization and attention to detail is everything.

In fact, CMS has strict guidelines for proper completion and compliance with their online PECOS system. One simple mistake can have disastrous consequences. Your provider could get kicked off of insurance panels and have their reimbursement stopped.

There’s a lot riding on your practice to get it right the first time.

You also don’t want to leave money on the table by under negotiating fee schedules, which could lead to years of lost revenue.

Let Mednet’s Professional Services Team use their decades of experience and know how to optimize your credentialing process, review your contracts, and negotiate them if necessary.

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The credentialing process:
  • Collect data
  • Update CAQH
  • Select top payers
  • Complete, audit and submit application
  • Submit supporting documents
  • Follow-up, follow-up, follow-up
  • Obtain enrollment number
  • Receive contract