CONTRACTING AND CREDENTIALING SERVICES

Why is provider credentialing so complicated? Every insurance company, hospital, and state maintains different rules, forms, processes and requirements. That's why MetroMedical has worked diligently at learning the special nuances of credentialing to help our clients avoid delays in the claims payment process.

Let our credentialing professionals with more than 18 years of experience handle all of your practice and provider credentialing needs.  Our experience submitting government and commercial insurance applications will help you minimize the turnaround time on your applications in order to process your reimbursements FASTER!

Contracting and Credentialing Service Topics

Individual Provider Enrollment

Credentialing is a verification process health plans use for approving physicians into their networks. Each payer grants approval after reviewing and verifying a physician’s education history, work history, licensure, malpractice, DEA, and National Provider Data Bank information. The verification process can be a very time consuming task. MetroMedical has created a team of professionals whose sole purpose is to complete the health plan applications and contracts in a timely manner to prevent delays in the credentialing process, which means timelier insurance reimbursements for you.

Each piece of physician information must be completely accurate with current addresses. For example, the physician’s curriculum vitae (CV) must include month and year dates for his or her entire education history and work history. For new physicians starting with your practice, their CV must be updated with their start date before submitting it to insurers.


New Practice Enrollment

Time and again new practices spend countless hours and money focused on office space, equipment, software and staffing only to open their doors for business and find essential delays in getting insurance reimbursements. More often than not, this situation can be avoided by addressing the insurance credentialing process early.

MetroMedical’s experienced credentialing professionals can complete your commercial and government insurance credentialing. MetroMedical has completed many new practice enrollments with great success.


As Needed Health Plan Enrollment

As new health plans move in to your general demographic area, new applications will need to be completed. MetroMedical can assist in completing these contracts and applications. With the Affordable Care Act, we have already seen new plans moving into the market.


Practice Demographic Updates

If you plan to relocate your office, you should update your demographic information as soon as you have your new address. It takes insurers between 4 and 6 weeks to update their systems. Until their systems are updated, all checks and notices will be mailed to your old address. In addition, some insurers like Railroad Medicare obtain their data from Medicare database. So if the Medicare system is incorrect, all of its subsystems will be as well.

If your practice names changes, you must update all payers with the new name reported to the IRS. If not, commercial and government payers can withhold a percentage of each claim reimbursement until the update is made.


CAQH Maintanance

CAQH has developed an online application which some insurance payers will use in lieu of their application. It is crucial to keep the CAQH application updated with your most current supporting documentation. When an insurance payer has access to view your CAQH application for re-credentialing and your supporting documentation is not current, this can cause delays or even termination from network participation.

If you do not currently have a CAQH provider ID, MetroMedical can obtain a CAQH ID for you. Once we receive the CAQH ID, MetroMedical will complete the online application (which takes about two to three hours) on your behalf and send you the attestation sheet to sign. Once these steps have been completed, you will be ready to start the credentialing process with those insurance payers who require the CAQH application for enrollment.


Re-Credentialing Services

The re-credentialing process serves as a tool for insurance payers to maintain their databases to ensure these network providers are completing their continuing education credits and keeping their licenses, DEAs and malpractice insurance current. .MetroMedical’s credentialing professionals have completed many of these applications over the years from a variety of commercial and government payers.


EFT Enrollment

Electronic funds transfer enables you to receive claims payments electronically. EFT allows for obtaining your claim reimbursements more quickly. Medicare, Medicaid, and Tricare require EFT enrollment. More and more payers are offering this free service to providers. MetroMedical will complete the necessary forms to enroll you in the EFT program with top insurance payers.

 

Pricing

Prices vary depending on your contracting and credentialing needs. Click here to receive a free quote.


 

Contracting Credentialing Services

3220 Office Pointe Place, Suite 101
Louisville, KY 40220
T:(502) 637-4579
F:(502) 882-7151

 

Jeannette Cheeks  -  Director of Credentialing and Contracting
Dianne Nethery  -  Credentialing and Contracting Manager