PROVIDER INSURANCE CREDENTIALING AND STATE LICENSURE

WCH, with over seven years of experience in these types of medical billing and collections, took a comprehensive approach to address the client's concerns. Not only did we provide an audit of their billing practices, but we also offered insights from a collection perspective. Our team members were well-versed in dealing with various payers, understanding their guidelines, and knowing how to bill CCM and RTM services correctly and efficiently. Upon investigating the client's billing, we discovered that their primary insurance providers were Medicaid HMO plans in the state of New York. We realized that, unlike Medicare, which follows federal policies consistently across states and plans, Medicaid HMO plans had their own unique policies and requirements for processing CCM and RTM services. These plans sometimes used different codes, and not all codes were uniformly utilized. WCH provided the client with a comprehensive understanding of the intricacies of billing for Medicaid HMO plans. We shared valuable information, provided links to relevant sources, and proposed a more effective billing approach. We helped the client identify the services they had rendered and guided them on proper billing procedures. This newfound knowledge empowered the client to streamline their billing process and serve their patients more effectively.

The client, impressed by the expertise and guidance provided by WCH, sought a second opinion and eventually decided to switch their entire billing operation to our company. The transition was seamless, and we continue to work closely with the client to ensure accurate billing processes, efficient collection methods, and consultations on expanding their services to multiple states. This case study highlights how WCH was able to address the client's pain points related to billing denials and revenue declines. By providing a comprehensive understanding of Medicaid HMO plans and offering effective billing solutions, we enabled the client to take control of their billing processes. The client's decision to partner with WCH has resulted in improved billing efficiency and financial stability. Never underestimate the value of seeking a second opinion or expert guidance when facing billing challenges. WCH is dedicated to helping healthcare providers navigate complex billing landscapes and achieve success in their practices. We look forward to the opportunity to assist you with your billing needs and help you overcome any obstacles you may encounter.