GreenThumb Revenue | Healthcare Provider Credentialing
Learn everything you need to know about healthcare provider credentialing with GreenThumb Revenue. We offer comprehensive resources and support to help you get started.
Requirements & Expectations
Yawn! So There's This Boring Thing You Should Read:
1. What is Healthcare Provider Credentialing? Healthcare provider credentialing is the process of verifying the qualifications and experience of healthcare providers. This process is important in ensuring that only qualified and experienced providers are allowed to practice in a given healthcare setting.
2. Who is Involved in Healthcare Provider Credentialing? There are a number of different organizations and individuals who are involved in healthcare provider credentialing. These include state medical boards, national professional organizations, and hospitals.
3. What Are the Steps of Healthcare Provider Credentialing? There are a number of steps involved in healthcare provider credentialing. These steps include verifying the provider's qualifications, experience, and licensure; conducting a criminal background check; and checking references.
4. What Are the Benefits of Healthcare Provider Credentialing? There are a number of benefits to healthcare provider credentialing. These benefits include ensuring that only qualified and experienced providers are allowed to practice, protecting patients from potential harm, and reducing liability for healthcare organizations.
5. What Are the Drawbacks of Healthcare Provider Credentialing? There are a few potential drawbacks to healthcare provider credentialing. These drawbacks include the potential for delays in care due to the credentialing process, the cost of the credentialing process, and the possibility of errors in the credentialing process.
First Things, First: Required Business Documents
Apply & Obtain an NPI 2 via NPPES
Professional Liability Insurance (with practitioner's names in the memorandum)
Practitioner's medical practice location
Legal business name of a solely-owned Professional Association, Professional Corporation, or Limited Liability Company (LLC) on file with the Internal Revenue Service and appearing on the IRS CP575
Special Payment Information
Any Federal, State, and/or local (city/county) business licenses, certifications, and/or registrations specifically required to operate as a healthcare facility.
i.e. Articles of Incorporation
Electronic Funds Transfer documentation (Voided Bank Check)
Second Step: CAQH and Supporting Documentation
Getting started:
1. Register with theCAQH Profile
2. Complete all application questions.
3. Review your data profile for accuracy.
4. Authorize participating organizations access to your data profile.
5. Attest to your data profile.
6. Upload your supporting documentation.
7. Ensure that your documents have been approved after submission
8. Please use this CAQH guide to walk you through the process.
Ensure that the NEW practice is active in CAQH as Primary Practice Location
If not done already, Apply and obtain an NPI 1 via NPPES
Copy of CAQH Summary Form
Copies of Professional License Information
Copies of any Certification information
Copies of State Licenses
Onboarding with Greenthumb Revenue
Once I have joined your Microsoft Teams Environment, you will be able to upload all of my secure documents to your private team. This will enable you to keep my data safe and secure from any unauthorized access. I will also be able to share these documents with other members of the team in a secure manner. It will also allow for better collaboration among the team members as well as make it easier for us to manage my documents in one place.
provider-user-guide
.pdf
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Here's a fast-track to growth 🏃♀️
💸 Choose Wisely: One or All-In?
At some point in your planning stages, you may have asked yourself the question: is it better to apply for one payer and hold on to the others? Or certify me individually or the entire group. The answer, of course, depends on several factors that are specific to your needs and those of your patients. In this blog post, we will discuss the pros and cons of both processes and help you determine which approach best suits your situation. We'll explore how individual and group application processes impact procedures such as documentation handling, compliance requirements, and costs associated with each process. By the end of this post, you should have a clear understanding of whether you should be watching from the mountain or jumping feet-first into the world of insurance credentialing.
If opted; Medicaid & Medicare
The initial pathway to success is ensuring that Individuals and Groups are equipped with the necessary certifications from Medicaid and Medicare. Doing so will create a solid foundation for future progress with managed care organizations.
Could this be the start of something special?
In our experience, if we get all the documents in a timely manner, it makes for smoother processing and helps us avoid costly delays. This is especially important when it comes to obtaining paperwork or other sensitive documents that require prompt attention. Additionally, having all the documents on hand ensures accuracy and efficiency in our workflow.
For those ready to begin their application process, a pre-application is a key first step. This stage of the process serves as a gatekeeper ensuring uniformity between submissions and disqualifying without board certifications. Once your pre-application checkmark has been received, you are in a fortunate position of making progress toward the main part of the application process.
No temper tantrums -- we got accepted to apply
Once your application for working with insurers is complete, the waiting game begins. Credentialing can take up to three months, but it's wise to add an extra two months of anticipation - just in case issues arise that prolong the process even further! To stay on top of healthcare credentialing and prepare yourself accordingly, familiarize yourself with any potential roadblocks before they become a reality.
We don't sleep on our Follow-Ups
Once we have applied, GreenThumb Revenue contacts the carrier regularly over the period of 15-30 days, we will be able to understand if anything else needs to be done in order for your application to be complete. Unfortunately, there is no way for you to speed up the process, however, by staying in contact with them regularly and following up, we can ensure the process does not stop or stall at any point. Once your application is finalized you will receive a notice of completion through either letter, email or fax.
Lucky for our clients, we utilize a project management tool that helps us track the status of all applications and provide updates, so our clients can rest easy knowing their application is being taken care of. Our team of experts is available to answer any questions and help with any issues that may arise during the approval process in real time
Stop Thinking Enrolling Payers is a One-and-Done Task
A provider credentialing file typically contains information about the healthcare provider such as their medical license, malpractice insurance information, education and training credentials, certifications, and any other relevant documentation required for credentialing. It also includes contact information for the provider's staff, such as office managers and billing personnel. This is especially important in order to ensure that all stakeholders are informed in a timely manner if details change, like an address. In addition to this fundamental information, it should also include records of the provider's continuing education courses (CME), updates to any expired documents or credentials; records of CAQH & Medicare revalidations; and updates to enrollment records when adding a service location or making other business changes. This helps make sure that the billing privileges are not deactivated due to incomplete enrollment records at insurance companies.
The importance of maintaining a complete and updated credentialing file cannot be overstated. Keeping on top of your healthcare providers' files is essential so that they remain compliant with payer requirements and have their payments processed without delay or disruption. Having an organized system in place to maintain these files is key - whether you handle it in-house or outsource to a qualified partner - in order for your organization to get the most out of its payer enrollments and maximize reimbursements for services provided.
Take Note 📝: This is your "exceptions to the rule" that Insurance Companies use, OFTEN!
When dealing with payers, it can be hard to keep up with their different processes and what is required for each. At GreenThumb Revenue, we understand that these requirements can feel overwhelming and that’s why we are here to help. We will work closely with you to ensure the necessary certification and credentials are met for individual or group contracts. We have years of experience in helping providers navigate the ever-changing regulations, so you can trust that we are well-equipped to take on the pressure of processing your applications.
