Introduction Organizations today aim to make their credentialing and contracting processes more efficient and compliant. However, this task can be challenging as these processes often involve different departments and people within an organization. To achieve the most efficient outcomes, collaboration…
Effective Management of Healthcare Contracts Contract management plans, organizes, and executes the activities required to manage the contract from start to finish. The role of this department is to make sure that all the processes are followed and no hiccups…
Before you begin any managed care contracting efforts, it’s important to outline your goals and objectives. This will help you prioritize your efforts and direct your attention towards the most impactful areas of your contracting process. Additionally, it will allow…
When it comes to negotiating reimbursement with your payers, it can feel like a game of whack-a-mole. You know the drill: You send in your bill or claim, and then wait for a response. After months or even years of…
Best practices for ensuring successful credentialing and contracting include: Involving healthcare professionals throughout the process by providing instruction on the selection of action words and phrases, the process for credentialing, and the importance of the documentation. If a provider is…
The first stage of the revenue cycle is payer enrollment. This process can be time-consuming and complex, but it is essential for ensuring that patients can receive the care they need. During payer enrollment, providers must submit accurate and complete…
The insurance industry is replete with acronyms, processes, and procedures. In fact, the majority of insurance professionals are quick to point out that much of what we do is “procedure heavy” rather than a more innovative industry. That’s why it…
The provider will be unable to bill the payer if the payer is not credentialed by the provider. If the insurance company denies a claim, there is usually a time limit for resubmitting the claim. It is even more problematic…
The credentialing process typically takes between 60 and 120 days, so it is important to plan ahead. During the credentialing process, a mistake can result in a delay, which requires that the process be repeated. Providers who are not properly…
A new UnitedHealthcare online portal has been launched that allows out-of-network providers to electronically register their taxpayer ID numbers and practice demographics. For out-of-network providers submitting claims to UnitedHealthcare, the following information is necessary and can be uploaded via the…
