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our time ~ your piece
of mind!
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The credentialing process absorbs a great deal of time and effort but
someone has to do it. Why not let us do most of the work?
Sure, it takes our time, too, but we can maximize the efficiency of our
time by dealing with multiple providers and multiple payors. This
volume allows us to actually specialize, focus, and concentrate on
credentialing whereas it is yet another distracting chore to juggle for
the individual provider or their office manager. Your time
spent in repetitive and redundant paperwork could be used to do something
else.
Key Benefits
- Reduced Administrative Burden
- Less Disruption
-
Faster Connection to
Payment Sources
-
Reduced Administrative Burden
- Delegated Credentialing
One feature of our contracting is to
secure delegated credentialing agreements with payors.
By doing this, we essentially become the facilitator
between the Payors and the Providers. The credentialing of a
provider whose credentialing is approved by PIPAC is accepted by all
contracted Payors. This is where it is good to have a facilitator.
In the credentialing world, PIPAC is like having some of the elements of
the switchboard operator, the mail room, and the front desk all rolled
into one. Whether a Payor or a Provider, in the words of
"Ghostbusters", Who ya gonna call?
- Centralized Data Collection
PIPAC maintains a HIPAA
compliant
file on each of our members. This is the record
that supports the information in our different
databases. Because we maintain the information that is necessary
for so many of our contracted Payors, we save our members time and
effort. For quality control, Payors
occasionally want to validate and verify that the necessary
documentation for credentialing is up to snuff and do a random check on
several of the providers in their network (it is debatable whether the
inconvenience is greater when done in person versus doing the whole mess
by fax). If the provider is a PIPAC member, guess who gets
audited? WE DO!! Let's see.... would you rather have
them in your office making you jump through hoops or have them in our
office making us jump through hoops? Hmmmmm. This is
especially handy if you have experienced some staff turnover (e.g. We
do know where the copy of your CLIA waiver certificate is filed).
- Easy Opt In / Opt Out
To officially opt in, Payors need to
have the providers signature. They also need a whole bunch of
other credentialing information -- but we take care of that.
All it takes is signing on to be an
authorized PAYEE with each of our contracted Payors.
- Decreased repetition of effort
One advantage of
having a centralized database of information, delegated credentialing,
and an organization that exists to benefit it's members is that your
staff doesn't have to repeat the effort of re-credentialing with
a multitude of different payors. They need only re-credential
through PIPAC. Our credentialing manager notifies members when it
is time to re-credential and starts
the process well in advance of the credentialing committee meeting so
that there is plenty of time to avoid the lapsing of current
credentialing. The staff also notifies all our contracted Payors
so that you remain current in their systems.
- Less Disruption
(Back to Top)
- Consolidated Site Surveys
Which would you prefer? One
reviewer or a dozen or more? When
Payors contract with PIPAC for delegated credentialing, this includes
the reviews involved in the credentialing process. A visit by the
PIPAC site reviewer precludes visits from multiple companies. The
inspection of the facility as well as the medical record reviews are
done on-site in one visit by a Registered Nurse. With PIPAC, the medical
record review requirements for all our contracted Payors are met by one
visit, on-site, by a healthcare professional accustomed to the sanctity
of patient confidentiality. No PHI leaves the office and, because
credentialing activities are part of Health Care Operations, consent
from the patient is not required.
- Quality, Member-Friendly Reviews
The PIPAC reviewer cannot
change or ignore the standards and requirements that are necessary to
preserve the integrity and reputation of PIPAC members. However,
the PIPAC reviewer will not leave you guessing about exactly what
the expectations are and will offer suggestions, recommendations, and
alternatives to resolve problems. We are committed to both quality practice and to our
members.
- Consultation
Questions? By virtue of visiting a variety of offices throughout
the state, we are familiar with a number of ways to deal with most
problems. We can describe the common practices in use as well as
the unusual and creative solutions that are out there. Chances are
good that questions you may have are ones that have been asked before,
researched, and answered. Feel free to call or, for those die-hard
do-it-yourself types, visit our links page to
research your question with various regulatory or advisory agencies.
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Faster Connection to
Payment Sources (Back to Top)
The most immediate practical benefit to member of our credentialing
services is to quickly connect providers with payors. That is the
bottom line to all the services listed above. This is especially
true when an existing PIPAC practice takes on and submits a new provider
for membership or when a new practice joins PIPAC. Approval and
acceptance of new members occurs monthly at our committee meetings.
Credentialing is done concurrently. Applications go to the
committee as soon as all the necessary verifications have been
completed. For those categories of membership requiring a site
visit and/or medical record review, this can normally be scheduled and
completed during the interval between application and all the
verifications being completed. Once membership is approved, new
members can opt in and, within approximately 45 days, begin billing any of our contracted
payors. A lot of doors can open at once for the new member.
For existing members, it is very handy to have someone tracking all
the expiration dates and other little things as well as initiating the
re-credentialing process with ample time to complete everything before
credentialing lapses. Once it's a done deal, we do the
notifications. This provides a relatively effortless and seamless
continuation as a credentialed member with all contracted payors.
To download a copy of the necessary uniform credentialing
application, visit www.insurance.gov.
Once the application has been completed, it can then be sent to PIPAC
Credentialing Manager, Carol Polosky who is available for assistance.
For More Information
Contact:
Carol Polosky -
Credentialing Manager
Preferred Integrated Provider Access Corporation
1212-B Van Voorhis Road, Morgantown, WV 26505
Tel: 304-598-0363
FAX: 304-598-0473
Internet:
carolpolosky@mountain.net
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