Anders Health Care can alleviate the burden on organizations that lack the resources to complete the provider enrollment process and manage ongoing maintenance by becoming an extension of your existing staff. Our provider enrollment services are tailored to meet your needs to ensure that your health plan or government payer enrollments are completed, renewed or revalidated, and maintained in a timely and efficient manner through:
- Data and document gathering
- PECOS and NPPES accuracy
- CAQH profile (initial or re-attestation)
- State Medicaid
- Managed Care Organization (MCO) universal rosters
- Provider directory, attestations (i.e. Availity, LexisNexis, etc.)
- Roster reconciliations
- ACH/EFT setup
- EDI setup
- Direct Data Entry (DDE)
- Completion and submission of applications
- Follow-up and follow-through until provider participation are received
- Provide our clients with continuous communication via emails and standing meetings
Maintenance
The process to manage expiring data and documents with payers during non-credentialing periods is crucial to prevent negative impacts to the revenue cycle. This requires ongoing monitoring of expiring documents, e.g., certifications, CME, malpractice insurance, etc. Anders uses automated alerts to ensure providers never become inactive with a payer as a result of noncompliance.
- CAQH profile re-attestations
- Change of information and updates
- Electronic Data Interchange (EDI) updates
- Managed Care Organization (MCO) universal rosters
- Medicare and Medicaid revalidations
- Out-of-state Medicaid revalidations
- Commercial payer renewals
- Direct Data Entry (DDE) updates
- Denials management (related to enrollment issues)
- Provider directory, attestations (i.e., Availity, LexisNexis, etc.)
- Provider data management
- Term facility/provider with payers
- Third-party liability forms
- Acting as a liaison between client, providers, payers and hospital credentialing entities
- Roster reconciliations