Provider Enrollment, Privileges, Medical Credentialing, & Contracting
Zetter HealthCare proudly provides enrollment and medical credentialing and contracting services in the healthcare sector. We assist with hospital privileging for clients that prefer to hire an external source to manage this work. Zetter HealthCare has over 20 years of experience with these services while working with payors in every U.S. state and territory. We have built a list of contacts with payors all over the U.S. and continue to build this list with every new contact we make. As a result, Zetter HealthCare is the better choice for your contracting needs.
Notably, there has been some confusion between provider enrollment, credentialing, and privileging. Different organizations sometimes call enrollment and credentialing by the same name. These names are both used to refer to provider enrollment, physician credential verifications, and hospital privileges. Medical credentialing is the vetting process for providers, whereas enrollment exists to “link providers to payors.” Contracts, on the other hand, are already established in order to ensure payment for services rendered. Hospital privileges, however, fall within the realm of credentialing. Hospital privileges occur when a provider receives the right to perform certain procedures and operations at a hospital. At Zetter HealthCare, we provide continuous and thorough updates regarding credentialing. In fact, we inform our clients that they may begin providing and billing for services on the same day that we receive approval from a payor.
Practices must gather the necessary data from their providers to get them credentialed. Then, they must submit similar data to insurance companies, hospitals, and payers. Credentialing initiates the gathering of the provider data that will need to be used for enrollments, hospital privileges, billing, and provider directories. Because of this, practices need to manage the way they track and maintain this data, rather than repeatedly ask its providers.
Enrollments can be a long and painful process if not done properly. This is because practices may have as many as 15 to 20 different payors, including Medicaid and Medicare. Some practices will have more payors depending on the state or regional health insurance offered. Every payor has a different process and turnaround time, ranging from 30 to 160 days. For example, Medicaid processes enrollments in 60 to 90 days. Medicare generally has the same guidelines but frequently requests additional information before they process the enrollment application.
Another example of the lack of standardization is the effective date for enrollments. Every organization (IPA, CIN, etc.) or insurance company has a different one. Some organizations use the date the paperwork was submitted as a retroactive effective date. Others may use the date the paperwork is received or even processed. Therefore, it is important for practices to familiarize themselves with the unique processes of each payer.
A common mistake that we see practices make is not leaving enough time for the enrollment process. This can cause practices to incur payer backlogs or have open positions that they cannot fill in a timely manner. In order to avoid these kinds of blocks in the workflow, practices can take into account how much time each enrollment will take. Practices will need to set up a system to track payers, provider data, and contracts. Zetter HealthCare handles the enrollment process completely. Unique to most credentialing companies in the country, we provide each client with copies of all executed contracts. Additionally, we generate full spreadsheets of all provided reimbursement rates for all plans and payors for your individual practice.
Our complete and thorough credentialing and contracting process assists practices in understanding every detail of their contracts. We provide our clients with fully detailed contract term sheets. Within these term sheets, clients are able to see the term of every contract they have including when it renews and terminates, specific terms, how they are paid, etc. at one glance. No other firm in the United States provides such an accurate and easy method to track contract overview.
If a practice is just getting started, they need to take into consideration the time it takes to establish contracts with payers. They will also need to consider the time it takes to link their organization to the payer and enroll their providers. There is no silver bullet with this process, and insurance companies regularly change their processes and rules. It is best to leave it to an experienced firm, like Zetter HealthCare, to ensure cash flow will occur right when the provider starts work.
The demands for medical practices to achieve clinical excellence and patient satisfaction requires more work than ever. Zetter HealthCare can quickly credential you with the necessary payors you require. If you are unsure which payors to work with, we can provide a list of payors that are available in your practice area.
Whether you are a solo practitioner, multi-specialty group, or a community hospital, our team of experts, we can help you start off properly. We also stay with you while you expand your business to ensure provider productivity and cash flow moving forward.
After the process is complete, we assist you with issues that arise regarding claim denials or payors. This includes out-of-network issues, documenting effective dates, proper claim reimbursement, and more. Because of this, Zetter HealthCare always receives documented proof and written verification so we can hold payors accountable.
Credentialing and provider enrollment options:
- Full Credentialing/Enrollment: Zetter HealthCare handles it all. We will complete all of the necessary payor forms and applications, CAQH, NPI enumeration, enrollment, Medicaid, and other third-party payor applications to gain in-network participation and contracts.
- Revalidations: We can complete the task of getting a provider(s) and/or groups re-validated with Medicaid and Medicare by processing all of the necessary paperwork. We receipt advance notice of your Medicare revalidations without you having to lift a finger.
- Re-credentialing: Every three years insurance companies are required to re-credential providers. Zetter HealthCare will automatically handle this for you, including fielding payor questions and requests.
Additional credentialing services include:
- Practice Start-Ups
- Physician Credentialing / Insurance Enrollment Services
- Nurse Practitioner & Physician Assistant Credentialing
- Annual Credentialing Maintenance
- State Licensure
- State and National DEA Certificates
- Medicare Enrollment Services
- ASC, Laboratory & Mobile Services Credentialing
- Hospital Privileging
We Keep You Informed
With Zetter HealthCare, you will receive regular updates from our experienced credentialing specialists. Plus, you will also receive payor rate comparisons and full reimbursement schedules from each payor along with contract terms to track the important details of each payor’s contract. Additionally, if you ever have questions or concerns, you always have access to speak with the founder of Zetter HealthCare directly to ensure your questions are always answered quickly and accurately.
Take Control of Your Practice’s Health
Profitability and longevity come from putting the right policies, procedures and processes in place. Let us help you become the leading healthcare provider in your region.