December 7, 2022 3:53 am
Provider Credentialing & Payer Enrollment
Provider credentialing is necessary to receive in-network reimbursement from payers. The ability to accept patient insurance plans is essential for the success of your practice. Procrastination and haphazard credentialing application processing can result in significant cash-flow challenges for your providers. Fortunately, there are ways to minimize issues with credentialing.
When you need credentialing
- 1. Opening a new practice
- 2. In need of a larger patient base
- 3. Adding providers
- 4. Moving or adding practice locations
- 5. Expanding payer networks
- 6. Mergers and acquisitions
- 7. Re-credentialing providers
TriumpHealth is here to ensure that your office obtains its credentials accurately and on time so that you can begin receiving reimbursement as soon as possible. Missed deadlines and incorrect documentation cause an already time-consuming process to become a nightmare. We have the experience and knowledge you need to get through the process with the least amount of worry. TriumpHealth experts keep tract of which applications need to be completed by whom and when. Your office simply needs to provide us with the required information and documents – and then leave the work to us!
What does TriumpHealth’s Provider Credentialing Services Include?
Credentialing is the process of validating that a provider meets standards for delivering care, this includes verifying the providers education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.
- Credentialing and Contracting
- New Group/Individual Provider contracts
- Adding / Deleting providers in the existing contract
- Adding / Deleting location(s) in the current contract
- Adding / Deleting plan types (Line of Business) within the current contract
- Provider Demographic Updates
- Provider demographic updates
What is CAQH?
Council for Affordable Quality Healthcare, Inc. (CAQH) eliminates duplicative paperwork with organizations that require your professional and practice information for claims administration, credentialing, directory services, and more.
- CAQH Registration & Attestations
- Revalidations
- Keep track of the expiration date for State DEA License, Board certificate, and Malpractice Insurance
- Tracking and Analytics
- Maintain all of the provider’s credentialing documents
- Maintain Contract agreements
- Track credentialing dates, expiration, and alerting dates to initiate credentialing processes
How Does TriumpHealth help?
- Our team analyzes the demographics around your practice location and shortlists the most beneficial payers for you, according to subscriber density, enabling you to make an informed decision for what works best for your practice
- We track all applications submitted and maintain accurate records
- We contact you regularly to update you on progress until the process is over
- We have a consistent follow-up process that ensures payer timelines are met
- We guarantee complete security, confidentiality, and accuracy of your data
- By trusting us, you can avoid common credentialing mistakes that lead to denials and underpayments
TriumpHealth Provider Enrollment Process
Documentation
Data collection of all legal, financial, and organizational documents frrom providers and organization for application filing and submission with private, commercial & government payers.
Application Submission and follow-up
Complete reconnaissance of current provider enrollment status. Submit applications with desired payers and complete timely follow-up with payers to track application statuses.
Ensure Enrollment
Receive countersigned copy of contract and / or verify that the provideer has in network participation with written confirmation from desired payer.