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Credentialing & Payer/Provider Enrollment Articles

10 Tips to Survive a Delegation Oversight Audit: If your organization or CVO has a delegation agreement with a commercial payer for
primary source verification, you know to expect an audit at least annually.

5 Ways PBMs and PSAOs Better Control Their Destiny Via Data Management: Automation could be the easiest and most cost-effective way for independent organizations to keep their footing amid the fast-shifting landscape.

ACA Update and Insurance Exchanges: A primer for credentialers on ACA and health insurance exchanges; includes a history & perspective.

Benefits of Electronic PE: 10 Tips for Improvement: Tips for recovering the max revenue in the shortest time for PE.

Credentialing a Moving Target: Locum Tenens: Numerous circumstances can create holes in a healthcare organization’s ability to meet community needs. Enter locum tenens providers.

Credentialing Red Flags: Red flag reminders for new and veteran credentialers.

Embrace E-Signatures: A sizeable part of the credentialing and enrollment industry’s efforts to go paperless hinge on electronic signatures (e-signatures).

For Commercial Enrollment: Delegate, Don’t Suffocate: No matter the type of healthcare facility, delegation to one or more payers is a practice that’s gaining traction.

In Pursuit of Paperless and Other Office Automation Goals: There’s little defense against the growing list of reasons paper must go. In which of these do you see your office reflected?

PE Pros Don’t Take Initial “No” from Payers: When it comes to enrolling providers in CMS and commercial insurance companies, much is out of your control. However, there are steps you can take after receiving a denial from a payer.

Six habits of dental and vision practices with strong enrollment, compliance, and reimbursement: A white paper that cites actions to positively impact reimbursement by engaging w/payers.

When PE Oversight Transitions to a Busy MSO: 1. Job Description: Part 1 includes due diligence, a staff analysis, and assessment of the payer universe. A job description for PE specialist is included.

When PE Oversight Transitions to a Busy MSO: 2. Workflow: Part 2 documents the flow to initially enroll and credential providers in multiple plans.

When PE Oversight Transitions to a Busy MSO: 3. KPIs: Part 3 establishes productivity metrics/key productivity indicators (KPIs) for starting out and for advanced assessment.