WCH Service Bureau - credentialing application eliminates the need for the healthcare provider to complete multiple insurance credentialing applications. From our years of experience in the healthcare industry we know that the importance of provider credentialing lies in the correct submission of a credentialing application, necessary paperwork and tracking provider credentialing applications along with the enrollment process of the insurance credentialing department side. The process of insurance credentialing requires a lot of patience and is time consuming, in which many practitioners may always be available. Our credentialing application is the most efficient and is qualified to handle your credentialing process.
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Absolutely, over the years we have learned to navigate difficult cases such as closed panels. It is true that with thousands of new medical professionals graduating every year, there is not enough space at insurance to credential everyone. Clients that hire WCH team to handle such case are assured that our credentialing specialists will use all available resources: contacts, evaluation of practice location region, database of participating providers in the area and apply our knowledge and expertise to help our clients get into closed panels. Alternative options will be also offered.
WCH is able to complete credentialing process for new providers within 90 days. Established providers that are making any changes, this process is complete within 60 days. Facility enrollment up to 180 days.
This depends on the patients’ insurance plan and benefits. Each patient has a specific health plan coverage that delegates the reimbursement and eligibility requirements. Nevertheless, the provider is financially responsible for seeing the patient prior to checking patient benefits and insurance credentialing requirements. From our experience, we can say that the majority of insurance companies prefer to pay contracted providers. Before making your decision speak with us, we can help create timeline and structure so that you get paid for your work.
Yes, you will have assigned credentialing specialist that will be the main person for communication between you and insurance company. You will be also able to speak with the department supervisor and manager.
At any time there is a rejection to an appeal or new enrollment, we don’t stop. Our job is to get our client enrolled with the insurance. There are several steps that can be done to request reconsideration or second level review. We have experience to handle rejected cases in enrollment and second level appeals to help our clients to become accepted by the insurance.
Usually, after approval the contract remains in place for three years, after this period insurances sends requests to confirm practice information. Agreement is only signed once during original credentialing. However, throughout the time of being participating provider, insurance will be sending information to the provider asking to update malpractice, license, DEA, etc. that’s why we have developed annual re-credentialing service to help clients with this paperwork and insurance responds.
Revalidation effects every credentialed Medicare and Medicaid provider. Medicare revalidation happens generally every 5 years. Medicaid revalidation takes place every 3 years. Each provider received a notice by mail to revalidate. Also, WCH can help determine your revalidation dates. It’s important not to miss your revalidation date, because this could lead to the contract termination, which will require again to reapply.
No, submitting application to the insurance does not provide guarantee that insurance will accept provider into the network. Before submitting the application it is important to find out if the panel is open for the provider specialty. Once the confirmation has been received the provider can submit application.
Our experience have shown that direct contracts are the best option for providers. However, considering the closure of plans for certain specialties, amount of time it takes to complete one application to join an insurance, IPA sometimes can work better for a practice. However, we consult our clients to always go directly. IPA should be a last resort for healthcare providers.
Yes, all pending cases or any type of open/closed case must be disclosed to the insurance company during credentialing process. CAQH must also reflect your most updated information. Supporting documents for each must be attached to demonstrate the details.