Credentialing

O’Sullivan Consulting Group performs this critical function for more than 50 providers. The credentialing is managed and maintained without interruption of staff time. Outsourcing medical credentialing provides greater control since the practice now has the ability to easily access this time sensitive and vital information.

Our Credentialing Process:

• Enters ODI information and catalogs the required documents.
• Sets up files with the corresponding insurance companies listed.
• Contacts the insurance companies and completes the required paperwork to begin the credentialing process.
• Sets up a credentialing spreadsheet; tracking the progress of obtaining provider numbers and effective dates of contracts.
• Applies for NPI and CLIA numbers, applies for DME license if requested, registers for CAQH, queries the National Practitioner Data Bank.
• Has very good relations established with the carriers which impacts the timeliness of the progress of credentialing. There is a continuous follow-up with the insurance carriers until provider numbers are obtained.
• Tracks the progression of obtaining a copy of the executed contract once all is final. Reviews the contract reimbursement amount and notifies the billing department of this significant payment information.
• Sets up procedures for adding a physician.
• Sets up procedures to notify carriers if there is a change of a   “Tax ID Number”, address and/or billing location.
• Sets  up credentialing process for
  • Nurse Practitioners
  • Physician Assistants
  • Occupational and Physical Therapists
  • Nurse Midwifes

Practice Changes...They Happen!

       Are you...

• Leaving an existing practice to start your own practice?
• Adding a physician or physician extender?
• Moving or closing your office?
• Finishing your training and looking to start a practice or join an existing practice?

Losing Money...It Can Happen!

• Tired of writing off unpaid claims because of credentialing issues?
• Are you aware of how many claims are being written off?
• Seeing patients, providing care and then receiving payments at the non-par status because the physician and/or location is not credentialed correctly?
• Receiving payments that are below your costs because the insurer rates are too low?

Let the Experts in Credentialing Take Over!