CREDENTIALING VS CONTRACTING
In today’s times, apart from offering the best quality of medical facilities, medical credentialing and contracting or provider enrollment are among the most important processes for any DME provider. However, very few DME providers are aware that credentialing and contracting are two distinct terms that requiring different action sets.
Every year, your medical practice could spend over $7,000 on each provider’s credentialing application.
OUR PROCESS
WWS collaborates with providers to establish which insurance companies and networks you want to pursue participation status with.Medicare, Medicaid, commercial carriers, and workers’ compensation carriers are examples of these carriers. We also apply for or update your CAQH database. Our credentialing professional completes your applications and monitors their status until they are placed into the carriers’ systems. In addition, your credentialing specialist will gather price schedules from contracted carriers and send them to you for use in the invoicing process.
- Our Streamlined Services gets your application process quickly, so it Saves your time and makes sure it gets you efficiently in Time by weekly updates to keep you informed throughout the process.
- Providing the highest quality of healthcare services – pandemic or no pandemic – should be the primary goal for healthcare providers.
- However, our providers are often bombarded with complex terms such as credentialing for insurance, contracting, payor enrollment, insurance participation, compliance billing, network management etc…
A single physician earns a facility an average of $2,378,727 per year. If credentialing that physician takes more than 8 weeks, the facility’s approximate gross revenue loss is estimated at around $150,000
CREDENTIALING AND PRIVILEGING MAINTENANCE PROGRAM
- Licensure coordination and maintenance, including notifying providers before credentialing papers expire.
- Maintain a relationship with the Council for Accessible and High-Quality Healthcare (CAQH).
- Requests for documentation, re-credentialing, and any applications must be completed.
CREDENTIAL VERIFICATION GUIDELINES
- WWS adheres to the National Committee on Quality Assurance (NCQA) credentials verification standards for managed care organizations, the Joint Commission for hospitals, and the Accreditation Association for Ambulatory Health Care (AAAHC) for surgical centers.
- Medical staff bylaws at some hospitals establish stricter credentials verification criteria than those required by the Joint Commission. When feasible, WWS collaborates with clients to attain greater requirements. WWS monitors expired papers and licenses (DEA registration, insurance certificate, licenses) and acquires fresh paperwork from suppliers in addition to application processing and primary source verification.
- In addition, WWS monitors the HHS Office of Inspector General Medicare/Medicaid penalty reports and state licensing board disciplinary actions and alerts clients of any negative information about practitioners on their current rosters.
