Once a managed care application is successfully submitted and verified, a final review should occur to confirm that the file meets the plan’s requirements before it is presented for final consideration by the credentialing committee or, if authorized, the medical director. This can be...
Being involved with provider enrollment entails being familiar with numerous complex processes to ensure your organization and its practitioners are reimbursed for their services. During the recent National Provider Enrollment Virtual Event, speakers fielded attendee-submitted questions about...
Credentialing Resource Center Journal - Volume 32, Issue 3
As the credentialing coordinator of a residency program, my role is split between the clinical practice and the administrative office of the residency program. Although my primary role is to ensure the providers in the practice are credentialed to see patients, I also provide administrative...
This month we continue our dive into the pain points that provider enrollment professionals face. During the recent National Provider Enrollment Virtual Event, speakers fielded attendee-submitted questions about the processes involved with enrolling practitioners and facilities with both...
Credentialing Resource Center Journal - Volume 32, Issue 2
MSPs can add value to their organizations by streamlining and unifying the credentialing and provider enrollment processes, leading to greater efficiencies and increased revenue, according to Lisa Velasco, MSM, LPTA, CPMSM, CPCS, director of professional services at The Hardenbergh Group in...
Board certification is a voluntary achievement by a practitioner to further demonstrate his or her knowledge and skills in a particular specialty. Although it is not required by any accrediting or regulatory body, many health plans do require as part of their credentialing criteria either board...
