Credentialing/Contracting
Credentialing is Critical
Credentialing of your providers is much more than just including them in the various payors/carriers/administrators. Initial and ongoing credentialing is critical to ensuring compliance in all aspects of the process and you, and your practice, remaining compliant with the various governmental entities.
With MPS Credentialing:
- All licenses are primary source verified.
- Alignment with the proper governmental agencies to ensure compliant participation.
- Core files created for each provider containing all needed information is readily available.
- Monthly reporting.
- Initial and ongoing queries of the necessary governmental agencies.
- Ongoing monitoring of licenses/certifications/ certificates/etc. to ensure expiration dates are not exceeded.
- Various agency attestation requirements are met to remain in compliance.
Contracting is Complex
Contracting with managed care organizations (MCO) is more complex than focusing on the reimbursement rate. The language of the contract is often not thoroughly reviewed. Provisions in the contract may create unnecessary burdens for the provider.
MPS CONTRACTING PROVIDES:
- Resources to identify and define leverage to enhance positioning for negotiations.
- Proactive review of each contract, alerting the provider of recommendations for revisions prior to renewal.
- Negotiate contract language and reimbursement rates, as defined by the business strategy and approved by the client.
- Prepare and maintain a core file with matrix(es) of contracts with a quick reference of key terms and reimbursement rates compared to the benchmark rate.
- Maintain payor relationships and initiate any contracting discussions.
