Credentialing services include application assistance, verification, as well as contract negotiation. One of the services we provide at Physician Practice Specialists is negotiating contracts with our healthcare providers. Here is more information on what credentialing is and how our services can help negotiate your contract:
What Is Credentialing?
Credentialing services help healthcare providers, such as physicians, nurse practitioners, dentists, and other medical professionals. These services assist in navigating the process of becoming credentialed with various healthcare organizations, insurance companies, and government agencies. Here are some aspects we can help healthcare professionals with:
Application Assistance
Credentialing assistance helps healthcare providers complete and submit credentialing applications accurately and efficiently. These applications can include detailed information about a provider’s education, training, licenses, certifications, work history, and any malpractice claims. During these services, we make sure that all documentation is gathered and submitted on time.
Verification
Verifying a healthcare provider’s credentials may involve contacting educational institutions, licensing boards, and previous employers. We do this to confirm the accuracy of the information provided by the healthcare provider.
Follow-Up
The credentialing process can involve communication with various organizations and agencies, with credentialing assistants acting as intermediaries. We can follow up on the status of applications, address any issues that may arise during the process, and proactively help make corrections.
Network Participation
Crediting with insurance companies and healthcare facilities can help healthcare providers expand their patient base and revenue potential. Our credentialing assistance assists providers in becoming eligible to participate in insurance networks. This may often be a prerequisite for insurance reimbursement and a larger patient reach.
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.
Contract Analysis
Credentialing services may also support contract analysis, helping providers review and negotiate contracts with healthcare facilities and insurance companies. We can verify that the terms of these contracts are suitable and aligned with the provider’s practice goals.
Time and Resource Savings
By outsourcing the credentialing process to professionals, you can save time and resources. You can invest that time in patient care, practice growth, and other healthcare business areas.
How Can Credentialing Services Help With Contract Negotiations?
Here is how we at Physician Practice Specialists can help with your contract negotiations:
Network Participation
Credentialing may be a prerequisite for healthcare providers to become part of insurance networks. When you are credentialed with a wide range of insurance companies, you can increase your patient base and revenue potential. Credentialing services like ours help make sure that your applications are complete and accurate. This may improve your chances of being accepted into these networks.
Negotiating Power
When healthcare providers are credentialed with multiple insurance companies and healthcare facilities, they may gain more negotiating power. Credentialing services can help you present a strong case during contract negotiations. The biggest thing this does it allow you to enter negotiations with some confidence. Depending on the specialty, you can leverage your patient relationships to encourage the payer to give you the best deal possible. If you are forced to terminate your payer relationship, the hope (and your expectation) should be that your patients will follow you with a payer that you continue to participate with.
Contract Analysis
Credentialing services involve reviewing contracts and making sure that they are fair, beneficial, and aligned with your practice’s goals. By understanding the specifics of your payer agreements, we can help you negotiate better fee schedules and terms for each payer. It’s important to conduct a thorough analysis of each payer contract and weight the CPT codes based on utilization.
Reducing Errors
Errors in the credentialing process may lead to delays in network participation and contract negotiations. Credentialing services like ours have the expertise to minimize potential errors.
Physician Practice Specialists
Our team can help you negotiate your contract to save time, increase negotiating power, and more. We can also help with other aspects of credentialing, such as application assistance, keeping with compliance, etc. Contact Physician Practice Specialists today to learn more about our credentialing services and contract negotiations.
Additional Sources for Further Reading
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Physician Practice Specialists:
- HIMSS.org- Certification