Credentialing Services for Hospital Employed Physicians

Keep up with the shifting healthcare landscape and ensure you are getting paid

The healthcare landscape is evolving fast. Our cloud-enabled hospital physicians credentialing services ensures that all of your multi-specialty providers are enrolled with your governmental, commercial, and exchange plans with minimal disruption, increased physician satisfaction, decreased credentialing denials, and increased revenue.

The Affordable Care Act (ACA) and the move to Population Health Management have forced hospitals to align themselves with physician groups at unprecedented rates – increasing the credentialing burden and the related administrative costs for hospitals. However, when it comes to hospital physicians credentialing, many hospitals and health systems institutions do not have the technology, expertise, or staff needed to successfully manage the revenue and operational components of their employed physician group’s credentialing life cycle.

Administrators looking for ways to improve revenue, reduce costs, and improve outcomes – without sacrificing quality of care – are turning to experienced hospital physicians credentialing partners like Newport for help. Newport specializes in managing the entire credentialing life cycle through the use of cloud-based workflow software, advanced cloud-based reporting, and analytics coupled with industry defining domain expertise. Administrators who work with Newport are successfully increasing their practice’s revenue and reducing denials associated with hospital physicians credentialing services.

Newport’s Value

Interactive approaches to corporate strategy foster collaborative thinking to further the overall value proposition.

Improve Revenue 100%
Bundled Software and Services 100%
Client Satisfaction 100%
Reduced Costs 100%

Newport’s Value

Interactive approaches to corporate strategy foster collaborative thinking to further the overall value proposition.

Improve Revenue 100%
Bundled Software and Services 100%
Client Satisfaction 100%
Reduced Costs 100%

Initial Credentialing Services

  • On-site or remote demographic and primary source documentation collection
  • Rapid data entry into our Cloud-Based workflow, analytics, and business intelligence software; CARE
  • Comprehensive Par/Non – Par Analysis
  • Missing demographic and documentation review
  • Application and signature page consolidation and management
  • Quality Assurance
  • Use of UPS, FedEx, and/or Certified Mail to track send and receipt of applications
  • Dedicated Application Follow-up
  • Extensive Payer Contacts
  • Compilation of all Provider Identification Numbers (PINs)

Expirables Management Services

  • Pro-Actively Monitor Document Expiration (e.g., license, DEA registration, board certification)
  • Conduct all CAQH Re-Attestations (every 120 days)
  • Expiring Document Report
  • Respond to Provider Enrollment Billing Issues/Edits

Re-Credentialing Services

  • Conduct all re-credentialing services based on insurance plan requirements
  • Quality Assurance
  • Application and Signature Page Consolidation and Management
  • Use of UPS, FedEx, and/or Certified Mail to track send and receipt of applications
  • Dedicated Application Follow-up

Credentialing Edit and/or Denials Management Services

  • Manage all credentialing related edits (stratified by dollar)
  • Manage all credentialing related denials (stratified by dollar)

Dedicated Account Management

  • Dedicated credentialing specialist to manage all aspects of your credentialing life cycle
  • Weekly dedicated meetings to review progress and performance
  • Weekly reporting to track performance

Advanced Reporting

  • Cloud-based, real time access to advanced institution wide dashboards
  • Ability to view financial impact of delayed credentialing by linking gross charges to “in-process” credentialing applications
  • Ability to develop your own KPI reports through easy to use, click, drag, drop reporting

Hospital Physician Credentialing

Physician Credentialing is the process of organizing and verifying the accuracy of a doctor’s professional records, training, competence, and ethics. As a physician, it is essential that all documents are accurate and all match. Problems begin when there are inaccuracies and discrepancies between various records. It is a good idea to contact your references before they receive a reference request, as problems can occur when professional references do not respond promptly.

The hospital physician credentialing process begins with the application. The application includes details of when and where the doctor has practiced or held licensing, as well as specifics such as his or her full name, educational history, and any diplomas or certifications. Potential employers or payors review and verify this information, checking educational account with the respective schools, accreditation with the appropriate boards, and ethical complaints with each state. The results of the investigation determine whether the physician should be hired, or in the case of a payor whether the physician will be permitted to a bill that insurance carrier.

When it comes to credentialing services, it can take months to maintain the database of a physician’s credentialing information and providing it to new carriers or potential employers as needed. This is where Newport steps in.

Our cloud-based credentialing services help to minimize the process of collecting up-to-date contact information, verifying background checks, investigating false claims and sending applications to the governing body for review.

Also, our highly-experienced account managers help to follow up on outstanding applications and make sure the credentialing process for hospital physicians is running smoothly at all times.

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