v-suite-provider-services-4mziy

Determining Your Payer Strategy

Sun, 08 Mar 2026 18:51:18 GMT

Payer strategy starts with taking the first step!

Managing your practice's patient schedule, ordering supplies, and developing your staff.. it all takes time and attention. Payer contracting and keeping up with credentialing updates can often fall off the radar until an alarm bell goes off. Was a revalidation date missed? Did a new insurance or IPA add a line of business that your providers are not participating with? These are the types of topics that might come up when you are trying to understand drastic changes in your denial trends.

Revenue Integrity isn't a buzzword, it is the backbone of any thriving medical practice. While coding, and accounts receivables might be the first department you think about when you are deep diving into patient financials - often credentialing & enrollments is an afterthought. We hope to change this!

Having a team to help you proactively track upcoming recredentialing dates, submit license renewal applications and update your payer directory attestations before they are due can help avoid revenue impacts down the road. When you are ready to grow your practice and add a new provider, an efficient onboarding process will ensure your new provider is in network before they begin seeing patients. Tip: Please expect this process to take anywhere from 90-120 days depending on the payer.

If you have been credentialed and contracted for some time without a clear picture of your payer enrollments, we recommend starting with the first step in our process which is payer discovery. What does payer discovery entail? Our team reaches out to each payer on your list to verify participation details, upcoming recredentialing dates and verify your practice demographics. If you do not have copies of your agreements, the second step will be to reach out to the payers to request a copy of your fully executed agreement and fee schedule matrix for your top codes.

With this information in hand, analyzing your top payer mix and reimbursements will give you crucial data to decide which payer contracts are helping your practice grow vs those that have remained stagnant. To help practices through this process, it all starts with an easy introduction call for us to learn where your.pain points are. Let's chat!

Spooky Stories | Provider Enrollment Edition

Fri, 31 Oct 2025 01:31:15 GMT

Spooky Stories | Provider Enrollment Edition

Some credentialing packets or payer portals are scarier than others, but in honor of MSP week coming up and for some Halloween fun we are giving a shout out to all of the Medical Services Professionals and Provider Enrollment Specialists who battle it all to get the job done!

A provider gives notice... right after you completed all of their enrollments!
You receive a request to credential a new locum provider, with 10 years of work history in nearly all 50 states.. Oof, we are over here wishing you luck!
Availity, PECOS and CAQH go down on the same day - Yikes, hang in there - keep refreshing!

A new provider starts Monday and no one told the credentialing team! Oh no! The team will need to divide and conquer - hopefully you can score some retroactive approvals.

An urgent email hits your inbox that your provider needs to provide proof of their CME credits to renew their board certification due today!

It brings up a memory of driving all the way down to the state licensing office with a hard copy renewal application, proof of CME and the renewal fee in hand on the day a physician's license was expiring..so thankful for the nicest licensing representative to helped get everything in.

At the end of the day, we would do anything to help the team!

RCM Depends on Efficient and Transparent Enrollments

Wed, 08 Oct 2025 02:19:34 GMT

Provider Enrollment should not come as an afterthought

With an efficient provider onboarding process, interdepartmental communication includes the key team members of recruitment, administration, provider onboarding, credentialing, scheduling and billing & coding. When these teams have clear timeframes and systems in place, there is appropriate time allocation for the provider to return the intake packet and supporting documents which is then reviewed and moved onto an assigned credentialing or provider enrollment specialist.

If recruitment and scheduling decide to start a provider within two weeks of accepting the offer, they run a significant risk of the provider starting to see patients while out of network with major insurance networks. Even with temporary hospital privileges, there will be a catch up period that can drastically impact revenue due to holding claims.

What are some of the top reasons for credentialing and enrollment delays?

Incomplete onboarding packets - missing or invalid license information, missing copies of diplomas and board certifications, incomplete or expired CAQH profile
Missing state license - If a provider is new to the state, they must have a license or temporary license issued to begin enrollments
Malpractice coverage - Administration needs to submit requests for malpractice coverage as soon as possible to insure that a valid certificate of insurance (COI) is available to upload into CAQH and submit along with all enrollments. Without a current COI, credentialing becomes a stand still.
Malpractice claims history, sanctions or other disciplinary actions
Supervising physicians for midlevel providers
Familiarize yourself with your state's scope of practice or supervising requirements by specialty.
Hospital privileges or admitting arrangement
Missing signatures or missing attachments.
While most networks have adopted digital/electronic application submission there are some that will still require a wet ink "original" signature and hard copy mailed application. We recommend using an internal checklist and application workflow to ensure that all signatures and submissions are complete.
Typos or incorrect application types
Yes this does happen, because as humans typos can occur! An efficient credentialing process includes a quality assurance workflow to catch errors before applications are submitted. Always double check when choosing the specialty, place of service, and enrollment type!
Outdated credentialing forms
This is somewhat at the discretion of the payer because they may accept an older application form when they have recently updated their credentialing packet. Otherwise they may reject the application and require a new submission.

If your team is feeling burned out by barely surviving a 90-120 turnaround time and the pressures of daily emails from the billing team wondering if they can release claims.. we promise there is a better way.

Automating intake and providing transparency to all stakeholders throughout the process is absolutely paramount to the success of Revenue Cycle Management!

Providers now required to update practice demographic info every 90 days

Mon, 01 Apr 2024 14:56:57 GMT

Are you a provider based in California?

Keeping up on state laws impacting providers, such as SB 137 helps to ensure that we have support to assist practices with compliance of the changing healthcare landscape. What is SB 137, and how does it impact providers? Let's jump in:

SB 137 requires commercial health plans and insurers to comply with uniform standards and provide timely updates for their provider directories. SB 137 provides patients with more accurate and complete provider demographic information to help identify which providers are in which insurance networks.

Transparency for patients is key!

What is SB 137, and how does it impact providers? Let's jump in:

Timely Communication with Insurers, and Accuracy of Demographic Information
Notify Whether a Provider is Accepting New Patients
Respond to Health Plan inquiries to validate the accuracy of your provider information. (Please be advised that Senate Bill 137 allows networks to impose the following penalties for non-compliance: removal from provider directory, delay of payment or reimbursement, or even termination of provider contract.

Even if you are located outside of California, you will see a greater emphasis in quarterly updates in Availity, CAQH attestations along with any provider portals with roster maintenance components.

It goes without saying, you will not want to let any of the moving parts fall off the radar to potentially cause a disruption in network participation. You can learn more about our credentialing maintenance services on our service page!

5 Important Steps to Simplify Credentialing

Mon, 04 Mar 2024 16:02:07 GMT

Keep it simple, you know what they say, "work smarter not harder!"

We already know that you are an expert in your field providing the best patient care; so we don't want you to have to try and wear the credentialing hat on top of that. You can however, be prepared and have a game-plan!

If we had to narrow down the top 5 - here are our picks:

Identify your priorities - are you joining an existing practice with established contracts or do you need a brand new group contract as well? Rather than try to be in-network with every payor possible - Instead prioritize the top payors in your area that the majority of your patients would present with. Once you are in-network, the fun doesn't end there!
Consolidate your credentialing data, think of creating a secure and accessible folder with your licensure, professional liability, hospital appointment letters, CME/training certs. and demographic details stored for ease of responding to requests for information
Utilize a team with expertise with credentialing that will partner with you for the entire enrollment process and re-strategize with you for future enrollment goals to grow with your practice.
Coordinate with your scheduling staff - credentialing information and status updates will be vital to your operations team when it comes time to schedule you with patients
Plan ahead - Track your license expiration dates, re-credentialing dates and CME totals in order to keep a watchful eye on upcoming re-credentialing dates and plan for completion of any required CME or attestations.

The most simple advice we can give, is work with a trusted team to manage these elements in order to free up your time and reduce the administrative burden of tracking or researching all on your own. Hop over to our services page to learn more!

Patients are looking for you!

Thu, 15 Feb 2024 15:54:56 GMT

Web Presence For Medical Providers

As consumers we expe ct to find information readily available when we are researching the newest tech device, or looking at reviews for restaurants we'd like to try. It may seem odd as a medical provider, but potential patience are using the web more than ever when it comes to seeing a new provider.

According to a survey by PEW Research, 44% of Internet users search online for doctors or other health professionals. When a patient does this search, often they are seeing outdated results from a provider's previous affiliations, old locations or the patient is not able to find accurate contact information.

By updating your NPI Registry details, and keeping your provider directory listings updated along with your practice website and website bio - Google will be able to "crawl" your sites and pull reliable information for patients to readily access.

After you Google yourself, give us a call!