Services

One of the most demanding tasks for any payer is establishing a new provider network or expanding an existing one. Many factors must be considered, such as the payer’s revenue and growth trajectory, potential for the network to lower medical costs, and viability of the network to meet the member’s needs.

These are just a few keys to a successful network build/expansion, and we explore how important they are to network administration. Since the contracting and credentialing involved is often time and labor-intensive, organizations rely on CredNet to streamline requirements and direct the who and the what required to accomplish these tasks. Which provider network strategy are you looking to overhaul? 

• Road to Delegation
• Auditing
• Compliance and Regulatory guidance
• Staff training and education

Our credentialing consulting services are designed to help healthcare providers and organizations navigate the complexity and often confusing process of obtaining and maintaining the credentials or verifying them in a timely manner. The consequences of incorrect credentialing are extreme or the consequences of delayed credentialing can be more costly and severe.  Providers incorrectly managed can be terminated from payer networks, lose hospital admitting privileges, and/or see dramatic reductions in new patients and revenue.

We offer a wide range of services, including process improvement, delegation, and the management of the entire process, either in-house or through outsourcing to a parent company or Credentials Verification Organization (CVO).

Closely related and often confused with credentialing, the process of enrollment entails submitting a request and asking to be enrolled as a provider with an insurance payer or requesting hospital privileging in an effort to treat the patients who trust the doctors so that are able to request services and receive payment from the payers or hospitals.

In order to complete the provider enrollment process and enroll a new provider, an application must typically be completed and submitted.

Like credentialing, enrollment can often be a very time-consuming and frustrating process.  Since each payer has their own unique requirements depending on the type of plan (state plan, federal plan or commercial health plan), the provider enrollment process often involves filling out and submitting several different forms and attaching several required documents. Missing even one detail during the enrollment process can result in serious reimbursement consequences. However, with a little guidance, you could avoid these devastating revenue delays and ensure that your reimbursement keeps flowing.

With thousands of provider groups, medical practices and ambulatory systems across the US, our goal is to drive improvement and optimize revenue. Each client has varied goals and objectives and this allows CredNet to reach the best fit your business goals. We bring opportunities that could lead to outsourcing or streamlining internal processes/functions, enabling our client to enhancement the margins and or the time to process.

Areas impacted include Denial management, Prior Auth & Eligibility, Contract Analysis, Auditing, Compliance and Regulatory Guidance.

We understand the importance of having a strong online presence in the healthcare industry. We will work with you to revamp your website, improve your brand, and increase your online visibility. This can include redesigning your website, improving the user experience, optimizing for search engines, and developing a content strategy to attract and engage patients and doctors.

We will help you develop and implement a marketing and advertising strategy to increase patient and doctor acquisition. This can include traditional marketing methods such as print and radio advertising, as well as digital marketing methods such as social media advertising, email marketing, and pay-per-click advertising.

We will assist you in identifying new business channels, opportunities and expanding your revenue streams. This can include identifying new referral sources, establishing relationships with payers, and identifying potential mergers and acquisitions.

Network Development: We will help you expand your network of providers and payers. This can include identifying potential providers, negotiating contracts, and building relationships with payers to increase reimbursement.