CredPro
HQ
Let Our Expertise bring Confidence & Ease to all of your Contracting & Credentialing Needs!
Why Chose CredPro HQ?
We are Committed to You!
Are you a Doctor, Nurse Practitioner or Physician Assistant seeking help with insurance providers? Look no further than CredPro HQ. Our team of experts is dedicated to providing fast and efficient assistance with payer enrollment, CAQH profile creation and maintenance, payer contracting and negotiation, and credentialing services. Let us help you navigate the complex healthcare insurance landscape with ease. We want to be your Healthcare Consulting Partner!
Contracting
&
Negotiation
Optimizing revenue collection is of utmost importance for healthcare practitioners and organizations.
Astonishingly, many offices fail to reevaluate their contracts, with even fewer doing so annually or during contract renewals.
Consequently, insurance companies may retain a significant portion, ranging from 10-25%, of your collections.
To avoid such pitfalls, it's vital to be proactive and renegotiate contracts to safeguard your earnings.
Contract Negoiation Strategy
At CredPro HQ, we offer managed care contract negotiation services to facilities and providers utilizing proven contracting strategies acquired through years of experience. Our expert team creates a personalized contracting strategy that aligns with the unique practice and objectives of each client. While it may take some time to successfully negotiate a contract, the outcome is typically rewarding.
Developing a Contracting Strategy
Our team uses years of experience in successful contract negotiations for physicians and payers to develop a comprehensive strategy. Key elements include identifying key payers, evaluating physician environment, determining market rates, identifying core competencies, evaluating competition, highlighting cost savings, and presenting outcome-based strategies to insurance companies.
Evaluate Current Contracts and Fee schedules
During the renegotiation process, reports are generated and analyzed to create an excel spreadsheet. This spreadsheet compares the payer's fee schedule to the current year Medicare fee schedule, using the most frequent CPT codes as a percentage of annual revenue. The outcome of the negotiations is then set based on these findings.
Contract Renegotiation
&
Consulting
The company evaluates contracts to determine if they meet the client's requirements and reflect the payer's rate accurately. During the renegotiation process, they suggest a percentage of Medicare to bill out, typically between 110%-150%, depending on insurance rates. The charges should be set at an appropriate level to capture all potential revenue, especially for contracts that pay a percentage of billed charges.
Estimated
Timeframe
Completion timeframe of contract negotiations varies depending on area and insurance companies. The process can take 90 days to 6 months, and constant dialogue between the client and CredPro HQ is crucial for success.
The Contract Negotiation Process
Average Estimated Timeline: 150 days
30-45
days
Initiate Process
Submit Negotiation Request
Typically, it takes 30-45 days for the Payer to acknowledge the receipt of your negotiation request, assign a Network Representative, and revert with their initial rate proposal.
45-90
days
Review
Evaluate Rate Proposal
It can take up to another 45-90 days to receive the initial proposal back from the payer. Depending on the network representative's responsiveness, each subsequent rate proposal may take 2-4 weeks.
Quick Tip
Your initial rate proposal should reflect the value you offer to the Payer network.
90-150
days
Finalization
Rates & Contract Terms
Finalizing rate negotiations and receiving a proposal from a payer can take 90-150 days, and the process can be prolonged by payers. The duration may vary based on individual circumstances.
Quick Tip
Establishing a positive rapport with a network representative and persistence are critical factors.
Credentialing
and
Payer Enrollment
CredPro HQ’s Credentialing services are designed to provide assistance to healthcare professionals including: physicians, nurse practitioners, dentists, and other independently licensed medical professionals. These services help navigate the complex process of becoming credentialed with various healthcare organizations, insurance companies, and government agencies. Here are some key areas in which healthcare professionals can benefit from credentialing services: Credentialing with insurance companies and healthcare facilities can help healthcare providers expand their patient base and revenue potential. Our credentialing assistance helps providers become eligible to participate in insurance networks, which is often a prerequisite for insurance reimbursement and a larger patient reach. Outsourcing the credentialing process to professionals can help save time and resources, allowing healthcare professionals to invest that time in patient care, practice growth, and other healthcare business areas.
CredPro HQ’s Credentialing and Payer Enrollment services include the following:
Application Assistance
Credentialing assistance helps healthcare providers complete and submit credentialing applications accurately and efficiently. These applications require detailed information about a provider’s education, training, licenses, certifications, work history, and any malpractice claims. Through these services, we ensure that all documentation is gathered and submitted on time.
Our customized Payer credentialing and enrollment services support physicians and healthcare practitioners in:
- Starting or joining a new practice.
- Transitioning to a new medical group.
- Participating in new activities or organizations.
- Signing up with a new insurance provider.
- Keeping up with their credentialing services.
Validation
The process of verifying a healthcare provider’s credentials may involve contacting educational institutions, licensing boards, and previous employers. This is done to confirm the accuracy of the information provided by the healthcare provider.
Follow-Up
Credentialing involves consistent communication with Payers, with credentialing assistants acting as intermediaries. We follow up on the status of applications and address any issues that may arise during the process and proactively help make corrections.
Tracking and Analytics
- Maintaining a repository of provider's credentialing documents.
- Maintaining Contracting agreements.
- Tracking credentialing dates, expiration, and alerting dates to initiate credentialing processes.
- Working with the denials team to understand if there are any claim denials due to credentialing issues.
Compliance and Updates
We stay current with healthcare regulation and requirement updates to verify that healthcare providers remain compliant with industry standards. This assists providers in avoiding penalties and maintaining their eligibility for insurance networks.
Additionally, CredPro HQ also offers:
Provider Data Maintenance
To meet compliance and regulatory requirements, Payers request up-to-date credentialing information. Our Provider data maintenance service includes:
- Updating providers' demographic information in Payer's specific systems, such as but not limited to: changes in the provider's address and service locations, area of expertise, or completion of advanced degrees.
- Update Payer's provider directory by validating information such as the provider's phone number, fax number, and address.
- CredPro HQ also offers assistance with Enrollment of EFT/ERA Applications.
Payer Enrollment Process
Estimated Timeline: 60-180 days
Documentation
- Collect Information via our CredPro HQ Credentialing Application
- Obtain all required supporting documentation
- All submitted information will be validated and stored and a centralized encrypted location for future access and providing renewed documents
Payer Submission
- The CredPro HQ Account Manager will assist in identifying the top payers in your area to help you get credentialed.
- Utilizing the information collected in the CredPro HQ credentialing application, submit the application in payer-specific format to the identified payers.
Quick Tip
By submitting "clean" applications to Payers, which include all required documentation and are free of errors, the credentialing processing times can be reduced by an average of 20 days.
Follow-up
- When dealing with payers, timely and persistent follow-up is crucial.
- Once the payer has granted approval, ensure that all provider information is accurately entered into their systems for proper billing.
Quick Tip
Did you know in some cases you can request expedited or provisional credentialing? Ask us how!
- To meet compliance and regulatory requirements, Payers request up-to-date credentialing information.
- Your CredPro HQ Account Manager will ensure that these updates are delivered to the payer promptly.
- Re-credentialing must be completed every three years, and your CredPro Account Manager can help you through this process.
Updates
&
Re-Credentialing
CAQH Profile Creation
&
Maintanence
What is CAQH?
CAQH is a not-for-profit collaborative alliance of the leading health plans and networks across the United States. The Council for Affordable Quality Healthcare's objective is to improve healthcare access and quality for patients while reducing the administrative requirements for physicians and other healthcare providers and their staff. CAQH acts as an online data repository of credentialing data that practitioners self-report, including demographic, educational, and training information, work history, malpractice history, and other relevant credentialing information. Health insurance companies can access this data electronically, reducing the burden of paperwork by eliminating much of the paper-based enrollment process involved with payor network enrollment and facility privilege applications.
How does CAQH work?
In order to participate with CAQH, you need a CAQH ID and username and password for the website. The new CAQH Proview allows you to obtain a CAQH ID directly from the website. By creating an online profile for healthcare entities to access your information, you can streamline the credentialing process. However, having a complete CAQH profile is just one step in commercial insurance credentialing, and other tasks must be performed to complete your credentialing and contracting with payers who participate with CAQH.
How can CredPro HQ help?
CredPro HQ offers assistance in obtaining your CAQH ID and completing your online profile. Our credentialing file maintenance plan includes the creation and maintenance of your CAQH profile, ensuring that insurance networks participating with CAQH always have access to current credentialing information.
Answers to Common Questions About CredPro HQ Services
When will you start on my project?
We will initiate your project within 2-3 business days of receiving your signed agreement and completed credentialing application with all required supporting documentation
How long does the Payer Enrollment process take?
The process of fully credentialing a new healthcare provider can take up to 90-180 days, although the duration may vary depending on the specific Payer. Majority of payers can complete the process in as little as 30-60 days, while others may take as long as 180 days due to extended processing times. However, the process may be expedited if there are existing group agreements in place since there would be no need to await the contract to be loaded.
What if you do not get me in network with one of the payers?
In the event of a payer declining to add your organization to their network, there are options available. At CredPro HQ, we are committed to resolving any objections or denials during the initiation process. Our team will advocate on your behalf and file any necessary appeals to ensure your successful inclusion in the payer network.
Can I hold claims and bill once approved?
Although some payers, such as Medicare and Medicaid, may permit retroactive billing, most commercial insurance companies do not offer this option. However, it's possible to bill as an out-of-network provider during the credentialing process, which allows you to commence work before all contracts are fully loaded.
Why should I use CredPro HQ for contracting and credentialing services?
Among the various companies providing credentialing solutions, CredPro HQ stands out with its unparalleled expertise in handling even the most complex situations. Our team has a proven track record of assisting numerous providers each year.
What is the duration of a contracting and or credenitaling agreement with CredPro HQ?
Our agreement remains valid for a year or until all services are rendered, whichever occurs first. The agreement can be renewed thereafter.
What happens after the first year?
Upon the completion of the initial enrollment project, you can choose to transition to a maintenance contract, which includes all your re-credentialing requirements.
Prep for Consult Call
Get in Touch
Mailing Address
Email Address
Phone Number
480-369-4008
1755 N Pebble Creek Parkway #1350
Goodyear, AZ 85395
adepriest@credprohq.com