CAQH: Definition, Explanation, Importance

Council For Affordable Quality Healthcare Defined And Explained CAQH: The Council Defined CAQH, or the Council for Affordable Quality Healthcare, is a non-profit organization of national healthcare networks and plan providers whose objective is to improve the quality of healthcare and its accessibility. It’s primarily designed for providers and their staff in order to eliminate […]

Understanding Your Provider Contract Fully

Provider Enrollment (Initial and Re-credentialing) – this is the process of enrolling a group or a provider with the insurance payers, also called payer enrollment or credentialing. It can often be a lengthy process depending on the payer and can sometimes take about 4 -6 months to complete. Providers typically do not have the time […]

Credentialing, Provider Enrollment, Privileging – isn’t it all the same?

Not really. While these 3 terms are often used interchangeably, they actually have different meanings: Credentialing, as defined by Joint Commission, is the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. During this process, which hospitals and health plans use, […]

Credentialing during Covid-19; How’s it like?

Credentialing efforts should be minimally burdensome to providers while expediting their ability to care for members during this unprecedented time. That’s why we are here to share with you the Credentialing/Recredentialing Standards during COVID-19 Emergency for Health Plans according to AHCCCS.  INITIAL CREDENTIALING  AHCCCS maintains the requirement that all providers shall go through the provisional […]

Outsourcing Credentialing and Provider Enrollment

When we meet with potential clients, some hesitate to externalize their credentialing and enrollment processes. Outsourcing, however, provides various perks and benefits that help your organization function at optimal levels, gain market share and increase profit. Operating costs are the expenses that are associated with a business’ day-to-day maintenance and administration costs. The total operating […]

Payor Contracting for Providers

Managing payor contracts is one of the main hurdles that every healthcare provider meets. From changing reimbursements to issues accessing networks and managing hidden clauses, contracts represent a significant hurdle that affects every provider, regardless of size. This is why we wanted to share with you the process of Payor Contracting for Providers for you […]

Different Healthcare Provider Contracts

As a healthcare provider, it’s essential to consider your opportunities when considering provider contracts for health care services. Unfortunately, not all provider contracts are created equal. Different types of Healthcare Provider Contracts have major differences in their payment systems that can significantly affect your revenue, the overall success of your facility, and even patient outcomes. […]

Provider Contracting and Everything You Need to Know

The provider contract is a vital element for any health care provider who wishes to operate a smoothly run facility with high patient satisfaction and on-time payments. However, there are many different types of healthcare provider contracts. Each is filled with lots of unfamiliar legal jargon and confusing clauses, amendments, and stipulations.  To get a […]

CAQH Set Up and Maintenance

CAQH is an online database that stores a provider’s historical information related to his medical education, licenses, malpractice history, practices that he currently works for, work history, and documents of all licenses, diplomas, board certifications, etc. The majority of payers require providers to have CAQH profiles as they use this information to credential and re-credential […]