Credentialing & Contract Management

  • 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.