Why outsource your credentialing? 

Health Business Navigators can streamline the process for you whether your practice or facility is...
....keeping up with payer applications to be credentialed and re-credentialed
....seeking privileges at a facility
....validating the credentials of your own staff through Source Verification

Whether you are located in a state that mandates the use of the CAQH application or your state has its own uniform application, or you need a proprietary facility or payer application completed, we can help. We will fill out the application, gather the needed documents to support it, have you attest or verify its contents, and house it so that an updated electronic version is available upon demand by you or designated parties. Your information is kept confidential and released only as authorized by the appropriate person at your practice or facility. We can even track the status of new provider applications with payers and work with the payers to answer any outstanding questions to ensure the most efficient processing of the application. And as licenses and other documentation are due to expire, we’ll seek the new documents though Internet sources whenever possible and save you the hassle of sending us copies.

HBN’s credentials HBN’s staff has decades of experience on both the payer and facility side of credentialing. We handle your credentialing program with many factors in mind. These include cost, efficiency, risk management, accreditation requirements, and a variety of other issues that we use to tailor your program to your needs.

HBN’s Credentialing Management Services have the potential to help you...

• Speed up the process of new physicians and allied professionals becoming “in-network” reducing time that billing needs to be held
• Have all of your providers’ applications up to date for payer or facility credentialing and re-credentialing on demand
• Track your Medicare, Medicaid, and Private Payer applications on a regular basis to ensure the receipt of and status of the application process
• Receive facility privileges or maintain NCQA, JCAHO, AAAHC or other accreditation
• Maintain quality measures and standards for your physicians or allied professionals
• Lower malpractice premiums
• Create/Maintain tailored marketing collateral, such as CVs, and other provider-specific material from your providers’ credentialing database housed at HBN
  

Health Business Navigators Credentialing Application Management Services and Charges

Determining the costs for your credentialing management program involves an initial simple interview with HBN. You will then receive a written quote based on the needs you identify. HBN knows how frustrating it can be to go through such a process without knowing an approximate price, so here are the program descriptions and prices that you might expect.

One Time Set Up

This puts your group or facility in our system including contacts, tax identification numbers (TIN), locations, billing and other information to which each of your provider’s information will be tagged. Depending on the number of TINs, locations, states, and other factors, the typical charge would be $400 to $500, paid only once.

The Basics

After group information is set up, HBN populates an electronic application for each provider (physicians and allied professionals). Depending on the state in which the provider practices and the purpose of the credentialing management services, this information will be mapped to any uniform application, such as CAQH, or to another state-mandated or facility application that is required. The Basics includes notification to up to 10 designated payers of the availability of your providers’ application through CAQH or HBN’s populated app. If HBN will manage facility privileges, a modest additional charge per facility will apply. The Basics program also includes electronic storage of numerous credentialing documents such as:

• State License
• DEA Certificate
• State Board of Pharmacy/Controlled Substance Certification
• Current and Previous Malpractice Proof of Insurance
• Educational Diplomas
• AMA, NPDB and Other Specialty/Profession Specific Reports
• Board Certificate or Letter of Acceptance
• Curriculum Vitae
• Continuing Education Information
• Other as required (TB Test Verification, W-9, UPIN, Other Unique ID)
  

The Basics charge per provider is typically about $425 to $500 per year.

Payer Tracking

After HBN has set up your providers in The Basics, you may need an initial credentialing application, re-credentialing application or other practice/provider updates monitored. With Payer Tracking, HBN tracks the credentialing application progress by contacting the payer or network to confirm receipt and follows it to completion, letting you know when the process is complete so that billing can be started.

For an existing practice in which the providers are already in the networks, adding this service will typically cost about $150 per provider per year. New practices that need HBN to initiate the group’s set up with payers and then follow the tedious process of completing each of the provider’s apps and tracking them over lengthy time periods, can expect this service to cost about $500 for up to 10 plans in the first year and then drop to about $125 in subsequent years.

(NOTE: You must purchase The Basics in order to purchase Payer Tracking.)

Continuous Updates

During the course of a year, a number of documents in your credentialing app will have expired. If you want all of your documentation continually updated as expiration dates approach, then HBN’s Continuous Updates is an excellent option to add to The Basics program. With Continuous Updates, you are assured that whenever a credentialing or re-credentialing event occurs your provider apps are current and ready to send. Most times we can find the updates on the Internet without having to contact you and can let you know if and when your providers need to re-attest updates. We take care of packaging and sending (electronic, fax, or USPS) the complete app and documentation to the authorized party for you. Adding Continuous Updates to The Basics generally costs an extra $125 per provider per year.

(NOTE: You must purchase The Basics in order to purchase Continuous Updates.)

Source Verification

If you need to go beyond completing, updating, and housing applications and supporting documents, we can also provide source verification of your providers’ credentials. After validating the accuracy of each provider’s credentials, we give you a comprehensive package of information on each provider based on NCQA, JCAHO, or your specific guidelines so your credentialing program complies with defined requirements. Ultimately, your organization, through its governing body, will determine whether each provider meets the credentialing requirements, but HBN does the legwork and facilitates the information collection, presenting a report in a format tailored to your needs and designed for easy review. Source Verification costs typically range from $175 to $200 per provider.

Criminal Background Checks

Some facilities or provider groups opt to order a criminal background check as part of the source verification credentialing process, while others simply make it a standard step in hiring. Whatever your reason, HBN will order a criminal background check, submit the results to you, and attach the results to your provider’s electronically stored credentialing application. The typical charge for this service is about $35 to $60 per check, depending on specifications.

Adverse Events

For providers with “red flags” in their credentials information, such as affirmative responses to attestation questions, sanctions, disciplinary actions, denials and/or trends in malpractice claims, HBN can gather information and provide guidance in drafting disclosure language in the hopes of maximizing opportunities for approval to participate with payer panels and facilities. These services are billed on an hourly basis.