When implementing initial credentialing and provider enrollment, Newport leaves nothing to chance. Our goal is to ensure 100-percent participation status with every payer for each provider at every location where they practice. By pairing our industry-proven provider enrollment software with the credentialing lifecycle expertise of our Professional Services team, we empower health systems to take full control of the physician hiring process.
- Participating and Non-Participating (Par – Non-Par) Analysis: Newport will conduct a comprehensive audit of all payers by provider and location to ensure that all missing or expired payer PINs (provider identification numbers) are identified.
- Council for Affordable Quality Healthcare (CAQH) & Medicare Provider Enrollment, Chain, and Ownership System (PECOS) Registration: Newport will set up and maintain all provider CAQH & PECOS accounts.
- Enrollment Application Processing: Newport will prepare and format all payer applications and route them to providers for signatures.
- Quality Assurance: Newport will implement both situational and organizational QA processes to ensure that accurate and complete information is provided to your payers.
- Application Follow-Up: Newport will perform rigorous and regular follow-ups on each application.
- PIN Compilation: Newport will immediately send all received PINs to your billing team so they can be entered into your patient accounting system.
- Denials Management: Newport’s team will actively work with payers directly to resolve credentialing-related denials and recover revenue rightfully owed to your organization.
- Full Service-Level Transparency: Newport clients enjoy access to on-demand dashboards and ad-hoc business intelligence tools to give them real-time visibility into the status of each initial credentialing and provider enrollment project.
- Productivity Tools: Newport clients enjoy access to a centralized, cloud-based document management archive and purpose-built software modules designed to reduce credentialing-related denials.
Interactive approaches to initial credentialing and provider enrollment promote collaborative thinking and strategic decision-making to advance the health of the communities you serve, improve the patient experience, enhance clinician satisfaction, and lower the total cost of care.
The Initial Credentialing and Provider Enrollment Processes
Healthcare organizations rely on the initial credentialing process. Without it, they cannot successfully manage the physician hiring process, the provider enrollment process, or the physician onboarding process. Insurance companies, or payers, also rely on the initial credentialing process. Without it, providers cannot participate in their network.
The requirements surrounding the provider enrollment process can make managing the credentialing lifecycle a long and tedious one. If healthcare organizations fail to manage this phase of the credentialing lifecycle correctly, it can directly impact their bottom line. Should physicians or allied health professionals begin treating patients before the provider enrollment process is complete, it can create compliance risks, generate claim denials, and negatively affect quality of care.
Credentialing teams typically spend months managing the primary source verification (PSV) process and other phases in the credentialing lifecycle (including privileging), working diligently to verify each provider’s skills, training, education, and licenses. Follow-up is necessary at every step in these workflows to ensure that all verifications are complete and accurate.
Next, once the provider enrollment process begins, that same data gathered during the credentialing process must be sent to insurance companies to secure a provider’s participation in health plans and achieve approval to bill plans for services rendered.
Tracking deadlines and ensuring that a provider remains properly enrolled is a time-consuming process that requires meticulous attention. Again, the financial impact of lapsed enrollment, which effectively prevents healthcare organizations from billing for services rendered by the affected providers, can be significant. It’s here that Newport’s provider enrollment and credentialing services can make a difference.
Using Newport’s cloud-based credentialing and initial provider enrollment platform, your organization can significantly decrease—or eliminate—lost revenue due to provider enrollment eligibility issues. We implement initial credentialing and provider enrollment workflow best practices that are backed by powerful analytics. By streamlining the entire credentialing lifecycle, diligently following up on outstanding applications, and proactively addressing claim denials, our Professional Services team can even help your organization move beyond cost-savings and begin recognizing additional revenue.
At the beginning of each engagement, Newport’s highly experienced Account Managers work directly with your key stakeholders to map out the most effective and efficient process for addressing both your immediate and long-term objectives. As they load your provider data into our cloud-based credentialing and enrollment enterprise solution, the Newport team also begins implementing your project plan and training your designated end users on how to access the dashboards, ad-hoc business intelligence tools, and software productivity modules to leverage your centralized initial credentialing and provider enrollment data.
Partner with Newport and let us help you take better control of your credentialing lifecycle. With our credentialing and initial provider enrollment software and services, you can get back to focusing on what you do best—improving the health of the communities you serve.