Provider Credentialing & Enrollment Maintenance

Simplify and streamline your provider credentialing. TriumpHealth will keep your data stored in one convenient place so you can effectively mange the status of your enrollments

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PROVIDER CREDENTIALING & PAYER ENROLLMENT

Provider Credentialing & Enrollment Maintenance Services

Provider credentialing and enrollment maintenance are critical parts of ensuring providers are reimbursed for their services accurately. If your credentials and documentation are not maintained and updated regularly, they will be deactivated by insurance payers, and denied claims will escalate. You do not want a missed payer request to end your agreement with any payer.

TriumpHealth’s credentialing specialists proactively and diligently keep track of your provider’s credentials and alert them before their documents expire. We ensure that the provider information stays up to date, including contact, location, licensure, malpractice insurance, education, experience, references etc. By staying ahead of deadlines, we remove the chance of any credentialing-related denials or the rush to renew information. Our goal is to make your credentialing maintenance as stress-free as possible so that you can focus on providing the highest quality of care to your patients.

Never Worry About Your Credentialing Issues Again With Our Maintenance Program

Each practice and healthcare organization is unique and may have different needs depending on the specialty, location, and goals. We try to understand your specific requirements and provide tailored solutions to help you be successful. We provide you with updated provider rosters and credentialing monitoring maintenance reports on a monthly basis. In addition, we give you access to our HIPAA compliant online portal, so you can monitor your credentialing status 24/7!

Our Provider Credentialing Maintenance Services Include

CAQH Maintenance & Attestation
Recredentialing and Maintenance of Private & Commercial Payers
Revalidations for Government Payers
Payer Demographic & Directory
Monitoring of Expirable Documents (DEA, License, Malpractice)
Addition of new provider enrollment services (included in practice maintenance fees)
Primary Source Verification

Focus on Your Work With Credentialing Maintenance Support Today!

We help hundreds of providers each year and can certainly help you as well. Our expert team provides comprehensive credentialing and enrollment maintenance services, ensuring that your credentials are always up-to-date and in compliance with regulatory requirements. We are committed to empowering you with the tools and knowledge you need to excel in your field.

Frequently Asked Questions

What is the importance of ongoing provider credentialing and enrollment maintenance for healthcare practices, and how does it contribute to continuous participation in insurance networks?

Ongoing provider credentialing and enrollment maintenance are essential for healthcare practices to maintain participation in insurance networks. By ensuring that providers remain credentialed and enrolled with payers, practices can continue to bill for services, receive reimbursement, and provide care to patients without interruption.

How do you manage the process of maintaining provider credentials and enrollment information, and what steps are taken to ensure compliance with changing regulations and payer requirements?

We manage the process of maintaining provider credentials and enrollment information by implementing a systematic approach that includes regular monitoring, updating documentation, and submitting renewal applications in a timely manner. We stay informed about changing regulations and payer requirements through ongoing education, communication with payers, and participation in industry forums.

Can you explain the typical timeline and frequency for provider credentialing and enrollment maintenance, and how do you minimize disruptions to healthcare providers during this process?

The typical timeline and frequency for provider credentialing and enrollment maintenance vary depending on payer requirements and regulatory standards. However, we aim to conduct these processes proactively and efficiently to minimize disruptions to healthcare providers. This includes submitting applications in a timely manner, following up with payers regularly, and providing support to providers throughout the process. The average time a provider can expect is 90-120 business days from the date of application submission.

What types of updates and documentation are typically required for provider credentialing and enrollment maintenance, and how do you streamline the submission and verification of this information?

Updates and documentation required for provider credentialing and enrollment maintenance may include licenses, certifications, malpractice insurance, and practice location information. We streamline the submission and verification of this information by centralizing documentation, utilizing a HIPAA compliant cloud based server and maintaining organized records to facilitate quick access and retrieval.

How do you stay informed about changes in credentialing and enrollment requirements from different payers and regulatory bodies, and how does this information impact your approach to maintenance services?

We stay informed about changes in credentialing and enrollment requirements through regular communication with payers, monitoring regulatory updates, and participating in industry associations. This information informs our approach to maintenance services by enabling us to adapt quickly to changes, anticipate requirements, and provide proactive support to healthcare providers.

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Our Process

Initial Assessment and Data Gathering

We gather all necessary provider information, including licenses, certifications, education, training, and contact details.

We conduct a reconnaissance of the practice’s current credentialing and enrollment status for all payers including all locations, tax ids, providers, etc.

Credentialing and Enrollment Management

Handle the entire credentialing and enrollment process on behalf of the practice, ensuring accurate and timely submission of credentialing applications to insurance companies and healthcare organizations.

Our team manages the verification and review process, ensuring that all documentation is complete and up-to-date.

Ongoing Maintenance and Compliance

Proactively monitor credentialing and enrollment expiration dates to prevent lapses in participation.

Handle re-credentialing and re-validations, including updating provider information and submitting necessary documentation to insurance companies when requested.

Manage contract maintenance, ensuring compliance with contractual obligations and negotiating terms as needed.

Continuous Support and Communication

Our company provides ongoing support and communication throughout the credentialing and enrollment process, promptly addressing any issues or discrepancies that may arise, and ensuring seamless participation in insurance networks.

Keep the practice informed of any updates or changes in credentialing requirements or regulations.

Benefits of Working with TriumpHealth

Provider Credentialing and Enrollment Maintenance

Comprehensive Credentialing Solutions

We manage initial credentialing, recredentialing, and all necessary follow-ups, streamlining your operations and keeping you compliant.

Dedication to Accuracy

Our detail-oriented team ensures that your enrollment information is precise, reducing delays or denials in reimbursements due to incorrect data.

Financial Security

Ensuring proper credentialing reduces the risk of cash flow disruptions caused by credentialing issues.

Peace of Mind

Rest assured knowing that your credentialing is managed by our experts, allowing you to focus on patient care with fewer administrative worries.

Our Results

Ready to Optimize Your MIPS Performance?

Let TriumpHealth be your partner in MIPS success. Contact us today to schedule a consultation and take the first step towards maximizing your Medicare reimbursements and enhancing your patient care standards.

I have been working with Triumph Health for about a year. I use their credentialing services. I went into it not knowing what to expect. They quickly put my fears to rest. I now have an entire team of professionals working on my behalf every day. My office has 3 locations and 20 Providers. Jessie is knowledgeable and stays on top of all requirements from the different payors. Choosing Triumph Health has been a great decision for my office.

Who do I trust as the linchpin for RCM in my practice? A question I asked myself repeatedly as I considered my options for Credentialling with Medicare and Commercial payers. TriumpHealth provided the expertise I needed in getting the work done effectively and efficiently. The project tracker, unique to TriumpHealth allowed me to follow progress and gain peace of mind. I recommend their services to everyone.

Having TriumpHealth on your side you can not go wrong. Everyone is so nice and helpful and won’t hesitate to get you answers. The credentialing team is wonderful and you can’t ask for more knowledgeable person than Kristy. Always willing to be there to help in any way. billing team is dedicated and patient to ensure we achieve great things. They are awesome!!

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.

Provider Credentialing & Enrollment Maintenance