Medical Credentialing
&
Enrollment Services
At Optimity Health Solutions, we understand that the journey to becoming an “In-Network” healthcare provider involves navigating through a complex web of forms, follow-ups, and continuous interactions with insurance companies. That’s where our dedicated service, the Optimity Credentialing and Enrollment platform, comes into play. We serve as your advocate, streamlining the payor enrollment (credentialing) and contracting process for healthcare providers.
Services We Provide
Medicare and Medicaid Enrollment
Comprehensive support for Medicare and Medicaid enrollment processes. Timely and accurate submission of required documents. Expert guidance to navigate the complexities of enrollment procedures.
Commercial Insurance
In-depth knowledge of various commercial insurance providers. Tailored solutions for optimal participation in commercial insurance networks. Assistance in negotiating favorable contract terms.
Recredentialing
Proactive management of recredentialing processes. Timely submission of recredentialing applications and supporting documentation. Monitoring and addressing any potential issues during the recredentialing process.
Appeals for Closed Panels
Expertly navigate appeals for closed panels. Strategically present compelling inclusion cases. Advocate for maximum participation in desired networks.
Enrollment for Electronic Transactions
We provide streamlined electronic transaction enrollment services. Our focus is on the implementation of efficient electronic data interchange (EDI) systems. Additionally, we ensure compliance with industry standards for electronic transactions.
PECOS, CAQH, and Portals Management
Expert setup and maintenance for PECOS and CAQH profiles. Quarterly attestations (CAQH & NPPES) for data accuracy and compliance. Ongoing adherence to PECOS and CAQH requirements. Additionally, comprehensive management of electronic portals in CA, including continual enhancement and building for optimal performance.
Application Follow Up
Proactive payer follow-up ensures swift processing. Continuous monitoring is conducted to address delays. Timely client communication is maintained regarding application progress. In-depth analysis is performed to identify bottlenecks. Regular updates are provided to stakeholders for transparency.
Annual Credentialing Maintenance
A proactive approach is taken to maintain up-to-date credentials with payers. Regular review of credentialing status and requirements is conducted. Continuous compliance with payer network standards is ensured.
Benefits of Our Credentialing and Enrollment Services!
Accelerated Credentialing: Swift and expedited credentialing with major payers.
Denial Reduction: Enhanced cash flow through minimized claim denials.
Referral Expansion: Access to a broader network for increased patient referrals.
Efficient Document Management: Streamlined paperwork via our secure document management system.
- Specialty Inclusion: Comprehensive credentialing services for all specialties.
Application Support: Expert assistance with complex application forms.
Cost-Efficiency: Reduced credentialing process costs leveraging our global delivery teams.
Timely Reporting: Regular and timely reports on the status of your applications.
Choose Optimity Health Solutions for a seamless and efficient provider credentialing and enrollment experience, allowing you to focus on delivering high-quality healthcare services.
