- Identify all managed care health plans available in the identified geographic area.
- Provide contract negotiations for managed care contracts on your behalf.
- Enroll physician(s) into all participating health plans and hospitals.
- Complete all re-credentialing applications and re-appointments.
- Obtain Medicare and Medicaid provider numbers.
- Obtain and Maintain CAQH.
- Obtain and Maintain NPI Numbers.
- Maintain current certificates; including: medical licenses, DEA and DPS certificates, malpractice face sheets, CLIA, board certification, PPD test, and CME’s. Reminder notices are sent at 60 and 30-day intervals.
- File and maintain your updated credentials with your local IPA’s and PHO’s; forward all updated licenses to contracted health plans and hospital affiliations.
- Request allowed amounts for your top 25 billing codes provided by each health plan.
- Assist the practice with a name change, Tax ID change, relocation, etc.
- Assist the practice in making sure the health plans have the correct demographic information on file.
- Maintain CME summaries.
- Obtain and complete all applications and agreements on your behalf.