When implementing initial provider credentialing and payer enrollment, Newport leaves nothing to chance. Our goal is to ensure 100% participation status with every payer for each provider at every location they practice. By implementing provider enrollment software alongside our services team, Newport is able to implement industry proven best-practices which promote rapid and accurate enrollment processing.
- Par/ Non ParAnalysis – A comprehensive audit of all payers by provider and location ensures that all missing or expired payer PINs (provider identification numbers) are identified.
- CAQH & PECOS Registration – Newport will set up and maintain all provider CAQH & PECOS accounts.
- Enrollment Application Processing – All payer applications are prepared, formatted, and sent to provider for signatures.
- Quality Assurance – Situational and Organizational QA processes ensure accurate and complete information is sent to the payers.
- Application Follow Up – Rigorous and regular follow up is conducted on each application.
- PIN Compilation – Received PINs are immediately sent to our client’s billing team to be entered in their patient accounting system.
- Denials Management – Newport’s team will actively work credentialing related denials directly with payers to recover rightfully owed cash.
- Full Service Level Transparency – Newport clients have access to on-demand dashboards and ad-hoc business intelligence tools to give them real-time project status.
- Productivity Tools – Clients have access to a centralized document management archive and software modules designed to reduce credentialing related denials.
Initial Credentialing & Provider Enrollment
Healthcare organizations use the initial provider credentialing process as part of their hiring process and by insurance companies to allow the provider to participate in their network. When it comes to provider enrollment, managing the credentialing life cycle can be a long and tedious process. When the credentialing life cycle is not managed correctly, it can negatively impact an organization’s revenue. With today’s requirements becoming more complex, having a poorly managed credentialing and enrollment processes can put a healthcare organization at risk when it comes to compliance violations and false claims.
The credentialing team typically spends months managing the primary source verification (PSV) process and other credentialing steps as they work to verify a provider’s skills, training, education, and licenses. Diligent follow-up is required along the way to ensure all verifications are complete and accurate. Next, there is the initial provider enrollment process, which leverages essentially the same data gathered during the credentialing process, to secure a provider’s participation in health plans and achieve approval to bill the plan for services rendered.
Tracking deadlines and ensuring a provider remains properly enrolled at all times is a time-consuming process that requires meticulous attention. Otherwise, when not properly managed, the financial impact of lapsed enrollment and not being able to bill for services rendered can be significant. That’s where Newport steps in.
Using Newport’s cloud-based credentialing and initial provider enrollment platform, lost revenue due to provider enrollment eligibility issues can be significantly reduced, even eliminated. Newport implements best practice workflow backed by powerful analytics to simplify the entire credentialing lifecycle for our clients. Our provider credentialing process helps to follow up on outstanding applications and claims diligently. The result will be an increase in revenue for the provider.
At the beginning of each engagement, our highly experienced account managers work directly with our client’s key stakeholders to map out the most effective and efficient process to address both immediate and long-term project objectives. As client data is loaded into the system and the Newport team begins implementing the project plan, clients are concurrently getting trained on end-user access to dashboards, ad-hoc business intelligence tools, and software productivity modules that take advantage of the credentialing data gathered thereby enabling clients to use this data in every-day operations. This is what we mean by “taking control of the credentialing lifecycle”! If you’re a healthcare organization that’s seeking to take control of the credentialing lifecycle, please do not hesitate to fill out the form below and schedule a consultation with us today!