Newport believes that its not only a matter of getting a provider enrolled, but you have to ensure that they stay enrolled. As a result, Newport manages the complete Re-Enrollment process including all Expirables Management services, Medicare and Medicaid re-validation services, as well as all CAQH re-attestations. The following is an overview of Newport’s Re-Enrollment Services
For those providers who are up for re-enrollment, Newport will conduct all Re-Enrollment Services. These services include:
- Newport will conduct all re-credentialing services based on specific insurance plan requirements.
- Newport will process all payer re-credentialing applications and or link letters as required.
- Newport will conduct both Situational and Organizational QA processes to ensure accurate and complete information is sent to the payers.
- Where applicable, Newport will package all re-credentialing applications with corresponding provider signature pages.
- Newport will use UPS, and/or Certified Mail to track and trend mailed applications.
- Newport will conduct verification that all payers have received the re-credentialing applications.
- Newport will conduct Follow-up on all re-credentialing applications to expedite processing.
- Newport will compile all obtained provider Identification Numbers (Pins) and transmit them to NEMG on a weekly / bi-weekly basis.
Provider Re-Enrollment and Re-Credentialing
Recent trends in provider network consolidation and expansion into new markets have created new challenges for credentialing teams. For many, the required workload to accommodate comprehensive payer enrollment procedures presents significant challenges. Not only do new providers need to be enrolled quickly and accurately, but existing providers need to be re-enrolled with their participating plans at varying intervals.
Re-credentialing/appointment is required every two to three years, CAQH re-attestation is required every 120 days, and re-validation enrollment is required every five years for Medicare. Keeping track of provider re-enrollment and re-credentialing is a tedious process, especially for larger hospitals or health systems.
When considering that most of the larger health systems employ upwards of 1,400 providers, managing provider re-credentialing and re-enrollment is a highly complex and daunting task. Without the resources and adequate processes in place to successfully manage these processes, things can quickly become unmanageable. Revenue and compliance issues are quick to follow.
Newport’s cloud-based services platform relies on the use of our proprietary software called CARE (Credentialing And Revenue Enhancement). CARE makes it easy for our services team to conduct regular audits for each provider and payer in order to maintain an active participation status with each insurance plan. Additionally, CARE offers clients with the ability to review all credentialing and re-credentialing data, access to realtime on-demand dashboards/ business intelligence systems, and work collaboration tools that provide notifications of any event which may require their attention.
A successful provider re-enrollment and provider re-credentialing initiative needs to be proactive, this means continuous follow-up on outstanding applications. Staff must be aware of upcoming deadlines and be diligent with follow-up. As part of Newport’s re-credentialing services platform, our credentialing specialists will work on our client’s behalf to ensure no deadline is missed and documentation issues are avoided.