INSURANCE CREDENTIALING SERVICES
The first and most crucial step in establishing your new revenue cycle, regardless of whether you run a small private practise or a major healthcare facility, is obtaining insurer credentialing. Nevertheless, obtaining credentials is a time-consuming and frequently difficult procedure, even if you already know which insurance companies you want to work with. This critical stage is outsourced by many healthcare companies for this reason.
Maxx Healthcare aspires to be your go-to resource for practise management. We manage insurance credentialing for hospitals, doctors’ offices, and many other types of healthcare organisations. We will guide you through each stage of obtaining acceptance from an insurance payer, from beginning to end. Find out why several healthcare organisations and professionals trust us with their medical insurance certification needs.
CREDENTIALING WITH INSURANCE NETWORKS
The success of your practise depends on your capacity to accept the insurance plans of potential patients in the current healthcare market. Medical insurance companies employ the procedure known as health insurance credentialing, also known as provider insurance credentialing, to allow you to apply to be included in their provider panels. You must go through the credentialing procedure if you want to bill an insurance company as an in-network provider.
To become an in-network provider on the insurance company’s panel, you must first demonstrate that you meet the company’s internal requirements. Your level of education, training, and professional experience may be considered.
NETWORK RESEARCH
We ensure that the in-network payor mix for your Practice or Group is the most diverse, well-liked, and successful.
Our credentialing staff has a wealth of expertise enrolling doctors in all Medicaid Managed Care Plans, Medicare, and commercial payors. Our team contacts each payor you want to enrol with from the shortlist to obtain precise timelines and open panel availability.
APPLICATION FILING
We will send you a comprehensive list of all the details and materials needed to submit the applications.
Due to our significant experience, as soon as we receive the information from you, our enrollment team immediately begins filing the required contract applications and ensures that it is a flawless submission on the first try. We can confidently claim the quickest turnaround time for obtaining the contract as a result of submitting our applications accurately the first time.
APPLICATION FOLLOW UP
Every two weeks, a member of our staff checks up on the submitted application to make sure it was received.
Until the contract is delivered to your physical address, we follow up frequently.
APPEALS FOR CLOSED PANELS
Payors like UHC, Aetna, and BCBS occasionally have closed lab panels for a certain region. We send a thorough, we promise.
Appeal detailing your service’s essential features, including any specialised offerings and information about how you provide the best patient care in your community. Your business plan includes all of these specifics and is delivered to senior provider officials at that payor. We have a 30% success rate in overturning closed panel judgements, despite the fact that it can be challenging.
OUT OF NETWORK ENROLLMENTS
This applies to all providers who opt to avoid participating in particular payor networks. Or if they must remain outside the network due to any closed panels. In order for your medical practise to be included in the payor’s system and begin receiving out of network payments, our staff assists with out of network enrollments, NPI registrations on the payor’s website, etc.
DEMOGRAPHIC CHANGES
We provide assistance with all straightforward and complicated demographic changes, including updating a new TAX ID with all of the payors in your payor mix, a new residence, a bank account, etc. In addition, we support full ERA and EFT enrollment setup.
ANNUAL CREDENTIALING MAINTENANCE
Accurate provider database management is essential for larger healthcare facilities that house several physicians. With our credentialing portal, we manage and uphold all of your providers’ and doctors’ credentialing information. We have created this thorough, open-book, HIPAA-compliant tool to ensure that we maintain your database as accurately and efficiently as possible.
CONTRACT NEGOTIATIONS
We negotiate price rates for you in addition to obtaining the contracts. All payors’ most recent charge schedules are available in our large database. We research your competitors, and this information enables us to guarantee that we secure the lowest prices for your procedures, securing the highest potential reimbursements for your medical practise. We review your earlier contracts and attempt to negotiate better terms with the payor based on current payor availability.