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 […]

Health Care Provider Roles

Care Providers are also known as Health Care Providers refer to a person or organization that provides healthcare service to individuals. Many different care providers offer a range of services – from primary and hospital care to diagnostic, rehabilitative, preventative, and palliative care. Health providers play numerous roles in the overall well-being of their patients. […]

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 […]

Negotiate Better Terms in a Provider Contract

The first step in any successful provider contract negotiation occurs long before you reach out to the payer with demands. Before engaging in formal negotiations, you should arm yourself with as much knowledge as possible. Familiarize yourself with your current contract, and research the legalese to become more comfortable speaking the payer’s language.  Then, engage […]

Four Phases of a Provider Enrollment Application

4 Phases of a provider enrollment application

Provider credentialing and enrollment with the payers is becoming more demanding and strenuous every single day. With most insurance panels getting a bulk load of work, due to the burst in membership applications. And a lot of them being particular about enrolling providers, the process of enrolling or registering your facility is becoming more challenging. […]