We streamline the process for

Physician Credentialing and Paneling

OUTSOURCE

Why outsource your physician credentialing and paneling?

With all of the other functions that practice managers, physicians and facilities have to address in running a medical practice, it can be cumbersome to keep up with populating, maintaining, submitting, and tracking credentialing applications for physicians and allied professionals. HBN can tackle your physician credentialing and paneling.

HBN can help.

Contact Us

Who can we help?

Whether you are…

keeping up with

payer enrollment applications for credentialing and re-credentialing, and linking providers to practice agreements and products

needing a CVO

to prepare documents for your committee that approves privileges to staff at your ASC or other facility

Needing assistance

with setting up and/or operating delegated credentialing

seeking privileges

at a facility such as an ASC, hospital, or SNF

validating the credentials

of your own staff through Primary Source Verification

Keep reading to see how HBN can help.

HBN Professionals are prepared for most any credentialing situation

We can help with…

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The Requirements

Including:

  • States that mandate the use of the CAQH application.
  • States that have their own uniform application.
  • Or proprietary facility or payer applications.
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The Application

  • We will fill out the application.
  • Gather the needed documents to support it.
  • Have you attest or verify its contents and  house it so that an updated electronic version is available upon demand by you or designated parties.
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Security

  • We keep your  information confidential.
  • We release information only as authorized by the appropriate person at your practice or facility.
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New Providers

  • We track the status of new provider applications with payers.
  • We work with the payers to answer all outstanding questions to ensure the most efficient processing of the application.
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Updates and Expirations

  • We seek updated documents through online sources whenever possible to save you the hassle of sending us copies.
  • We send you reminders for documents needing updating.

Our Experience

HBN’s staff has decades of experience on both the payer and facility side of credentialing. We handle your credentialing program with many factors in mind, including cost, efficiency, risk management, accreditation requirements, and a variety of other issues that we use to tailor your program to your needs.

HBN’s Credentialing Management Services can help you…

  • Speed up the process of new physicians and allied professionals becoming “in-network” reducing denials and time that billing needs to be held
  • Keep all of your providers’ applications up to date for payer or facility credentialing and re-credentialing on demand
  • Track your Medicare, Medicaid, and Private Payer applications on a regular basis to ensure the receipt of and status of the application process
  • Receive facility privileges or maintain NCQA, JCAHO, AAAHC or other accreditation
  • Maintain quality measures and standards for your physicians or allied professionals
  • Lower malpractice premiums
  • Create/Maintain tailored marketing collateral, such as CVs, and other provider-specific material from your providers’ credentialing database housed at HBN

Details

How Our Credentialing Services Work

HBN’s Credentialing Application Management Services

Determining the costs for your credentialing management program involves an initial simple interview with HBN. You will then receive a written quote based on the needs you identify. HBN knows how frustrating it can be to go through such a process without knowing an approximate price. Many times HBN clients have discovered through denials or other signs that credentialing has not been unattended, but are uncertain exactly what kind of shape the practice’s credentialing is in or even what payers and networks are contracted.  In these instances HBN can propose a research project that usually takes a few weeks, at the end of which HBN will meet with you and provide a more accurate snapshot of the work ahead and the budget for clean up and maintenance of credentialing. Similarly, if you are starting a new practice, HBN will gather certain information from you and then can do some research with payers to determine the status, starting points and estimated timelines for initiating credentialing. And while credentialing and contracting are separate functions, sometimes the research can flush out whether the practice is under group or individual agreements and what products might be included. If contracting assistance is also desired, HBN teams up a credentialing and contracting specialists to work together on your project.

Research the Project

Depending on the number of payers and providers involved, HBN will provide a fixed project price to research, through the payers, the credentialing and contracting status and estimated timelines to achieve your project goals. This includes a summary report and a brief meeting to discuss findings and next steps. There are several services that make up a credentialing engagement.  These are One Time Set Up, Basics, Payer Tracking and Continuous Updates.  These must be purchased together and are not sold a la carte.  When HBN is hired to perform and maintain payer enrollment credentialing, we set up and/or maintain the practice and providers in our workflow management software, prepare apps for review and signature, submit apps, update and attest provider portals such as CAQH, follow up on apps, and advise you of the outcome and respective effective dates.

One-Time Setup
This puts your group or facility in our system including contacts, tax identification numbers (TIN), locations, billing and other information to which each of your provider’s information will be tagged. Depending on the number of TINs, locations, states, and other factors, the typical charge would be paid only once and not paid in subsequent contiguous years.
The Basics
After group information is set up, HBN populates an electronic application for each provider (physicians and allied professionals). Depending on the state(s) in which the provider practices and the purpose of the credentialing management services, this information will be mapped to any uniform application, such as CAQH, or to another state-mandated or facility application that is required. The Basics includes notification to up to 10 designated payers of the availability of your providers’ application through CAQH or HBN’s populated app. If HBN will manage facility privileges, a reasonable additional charge per facility will apply. The Basics program also includes electronic storage of numerous credentialing documents such as:

  • State License
  • DEA Certificate
  • State Board of Pharmacy/Controlled Substance Certification
  • Current and Previous Malpractice Proof of Insurance
  • Educational Diplomas
  • AMA, NPDB and Other Specialty/Profession Specific Reports
  • Board Certificate or Letter of Acceptance
  • Curriculum Vitae
  • Continuing Education Information
  • Other as required (TB Test Verification, W-9, UPIN, Other Unique ID)
Payer Tracking
After HBN has set up your providers in The Basics, your providers will likely need an initial credentialing application, re-credentialing application or other practice/provider updates monitored. With Payer Tracking, HBN tracks the credentialing application progress by contacting the payer or network to confirm receipt and follows it to completion, letting you know when the process is complete so that scheduling and billing can be managed on your end. If a provider is NEW to HBN the Payer Tracking fee in the first year is higher than the charge in subsequent years because there is usually far more follow up in year one of the services.  In subsequent years there is still a Payer Tracking fee but it is considerably lower in subsequent years.
Continuous Updates
During the course of a year, a number of documents in your credentialing app will have expired. HBN continually updates these as expiration dates approach under HBN’s Continuous Updates program. With Continuous Updates, you can have the confidence that whenever a credentialing or re-credentialing event occurs your provider apps will be current and ready to send to payers. Most times HBN can find the updates online without having to contact you and, if not, we will reach out for updated documents and can let you know if and when your providers need to re-attest updates or sign documents. We take care of packaging and sending (electronic, fax, portal, or USPS) the complete app and documentation to the authorized party for you.

Beyond Payer Enrollment

While HBN’s most common credentialing engagement involves the services just described, some clients have unique needs beyond payer enrollment. To assist with these HBN offers the following: 

Source Verification

If you need to go beyond completing, updating, and housing applications and supporting documents, we can also provide source verification of your providers’ credentials. After validating the accuracy of each provider’s credentials, we give you a comprehensive package of information on each provider based on NCQA, JCAHO, or your specific guidelines so your credentialing program complies with defined requirements. Ultimately, your organization, through its governing body, will determine whether each provider meets the credentialing requirements, but HBN does the legwork and facilitates the information collection, presenting a report in a format tailored to your needs and designed for easy review.

Criminal Background Checks

Some facilities or provider groups opt to order a criminal background check as part of the source verification credentialing process, while others simply make it a standard step in hiring. Whatever your reason, HBN will order a criminal background check, submit the results to you, and attach the results to your provider’s electronically stored credentialing application. The charge for this service may vary depending on the type and scope of background check requested.

Adverse Events

For providers with “red flags” in their credentials information, such as affirmative responses to attestation questions, sanctions, disciplinary actions, denials and/or trends in malpractice claims, HBN can gather information and provide guidance in drafting disclosure language in the hopes of maximizing opportunities for approval to participate with payer panels and facilities. These services are billed on an hourly basis.  

Get In Touch

Contact us for more details, to schedule a demo, for pricing, or to make arrangements for your customized tool to be developed.

Health Business Navigators
760 Campbell Lane, Suite 106-160
Bowling Green, KY 42104
Tel: 270-782-7272
Fax: 770-234-4245
info@healthbusinessnavigators.com

CPT is a registered trademark of the American Medical Association.