Credentialing & Contracting

Credentialing & Contracting

Credentialing & Contracting is at the heart of any medical practice. Medicus Results Credentialing & Contracting services provides for the seamless management of all required documentation and requested follow-up to ensure your providers are credentialed and contracted in the most expeditious manner possible.

What is Credentialing & Contracting?

Credentialing is the process of organizing and verifying your professional records. Your NPI, CAQH, professional licenses, diploma’s, certifications, attestations and professional references are your credentialing documents. The process of credentialing is to verify the accuracy and specific data in your documents.

Insurance carriers and hospitals will perform a Primary Source Verification which is the process of requesting and receiving verification of your stated credentials from the College or other entity that issued the diploma or certificate. In addition, they have a legal responsibility to verify each provider’s identity, education, work experience, malpractice history, professional sanctions and license verifications to protect patients from unqualified providers.

The Affordable Care Act has substantially increased credentials verification requirements for Medicare and Medicaid enrollment in an effort to reduce Fraud and Abuse. Insurance plans must meet increased credentialing requirements including periodic re-credentialing and attestation.

It is very important that your documents are accurate and they all match. Problems begin when there are inaccuracies (such as a change of address or practice ownership) and discrepancies between various records. Another problem area can occur when professional references do not respond in a timely manner. Thousands of dollars can be lost and payments may be interrupted if there are errors or inconsistencies in your credentialing and re-credentialing.

This process generally takes 60 to 90 days to complete.

Contracting is the process of applying for and obtaining participation with insurance plans. Often providers enroll in a plan and then never review the performance of the contract. Years go by, insurers do not update your contract to reflect updated reimbursement rates. Performing a periodic review of your contract performance and updating of your contracts is essential to optimizing reimbursement.

Upon successful completion of the Credentialing process, Contracting generally takes an additional 60-90 days to complete.

Credentialing and Contracting is our specialty. Let us help you organize and manage your credentialing and contracting responsibilities to ensure optimization of your revenue.