Credentialing

The majority of physician practice revenue is generated from Medicare, Medicaid and managed care plans. Obtaining contracts with these organizations is critical to the financial success of the practice. Having contracts in place when a new physician is ready to start seeing patients is important so that the physician can get reimbursed for the services rendered without having to bill the patient for out-of-network services. With reduced workforces at many payer organizations, getting the right information to the right individuals in an expedient manner can mean the difference in getting the physician on the plan panels in a reasonable time period. MMA has the experience and technical expertise to insure that the credentialing process is accomplished in a timely manner.

MMA’s Credentialing Services include a comprehensive array of services.

Our scope of services includes:

• Participation strategy.
• Registration or updates to the National Provider Identification Number (NPI) database.
• Completion of CAQH application (as applicable) or update to the current data assigned to the physician.
• Coordination of applications to the hospital’s PHO.
• Completion and submission of Medicare application and follow-up.
• Completion and submission of basic Medicaid application and follow-up.
• Coordination of applications and attachments and mailing for major managed care plans and payer networks, or Medicaid CMO’s.
• Weekly follow-up with payers regarding credentialing status for 8 weeks.
• Periodic status reports following submission of the application or until transitioned to designee.
• Copies of contracts and credentialing applications to the practice during the transition of follow-up responsibilities.