Unlike most credentialing companies, Newport focuses on the impact credentialing has on the healthcare revenue cycle. As part of our services engagement with each client, the Newport team will proactively work the credentialing related denials directly with the payers. Newport requests that our clients send us monthly edit and/or denial reports (with no PHI) based on line item charge detail. We then stratify the edits and/or denials by provider with the greatest number of charges to ensure that we are working the providers with the greatest number of charges associated with their in-process applications. Newport also works a “Top 25” Provider report whereby we provide weekly updates on the top 25 providers with the greatest number of charges related to their in-process applications.
- Reduce claim write-offs stemming from credentialing issues.
- Free up billing staff to focus on non-provider credentialing denials.
- Prevent underpayment of services caused by out-of-network reimbursements.
- Promote patient satisfaction by reducing unwarranted out-of-pocket patient expenses.
Credentialing Denials Management
Denied claims caused by credentialing-related issues have an obvious impact on a provider’s reimbursements. The inability to collect on denied claims nearly always lead to writing off the claim and stopping the pursuit of reimbursement. Given just how many patient encounters a provider has in a given day, week or month, the financial impact of having to write off an otherwise valid encounter can be significant. The process of getting payers to reverse these types of denied claims requires a meticulous accounting of the steps taken to getting the provider’s enrollment status activated and the subsequent steps taken to keeping the provider’s enrollment status active.
As part of Newport’s credentialing services platform, our credentialing specialists will work on our client’s behalf to systematically petition any credentialing related edits and denials for each of their payers. By understanding the nature of what drives credentialing related denials, our team has on-demand access to received PIN reports, CAQH re-attestation schedules and all provider credentialing data which – when kept current – can be used to get many of these denials reversed. We then provide an updated line-item status for each of the claims that can then be loaded into our client’s patient accounting system.