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 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 […]

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. […]