Credentialing & Enrollments
INSURANCE CREDENTIALING SERVICES
Whether you are a private physician or a larger health care provider, insurance is the first and most important step in realizing your new income cycle. However, even if you know which insurance companies you want to join, obtaining referrals is a time-consuming and often frustrating process. Therefore, many healthcare organizations are outsourcing this important step.
Royal Edge Solutions Healthcare wants to be your Practice Management Concierge. We manage insurance coverage for doctors, hospitals and many different healthcare institutions. From start to finish, we will guide you through every step of approving the insurance payer. Find out why countless healthcare professionals and organizations rely on us to provide health insurance services.
LOAN AT INSURANCE NETWORKS
In today’s healthcare market, the ability to take insurance plans with potential patients is critical to the success of your practice. Health insurance letters, also called insurance confirmation letters, are the process used by health insurance companies to apply for inclusion on provider panels. If you want to pay the insurance company as a network provider, you have to go through a proof process. First, the insurance company you apply to will verify that you meet its internal requirements in order to serve as a network provider in its panel. This may include your level of education, training and professional experience.
Once your practice or organization has confirmation from the insurance company, you can immediately return the money to the payer. Many insurance companies also offer providers and other incentives such as:
- Reference.
- Preferred payment fee.
- Include their web directories so that consumers can find you as a participating provider for your particular specialization.
With Royal Edge Healthcare Solutions we help you complete your applications twice as fast for Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, TRICARE and almost any other provider. Below are some of the features we performed for you during the registration process.
NETWORK RESEARCH
We will ensure that your practice or group has the most diverse, popular and efficient payment mix on the net.
Our commissioning team has extensive experience in enlisting Medicare physicians, all Medicaid Managed Care plans and all commercial payers. Our team will contact each payer on the shortlist you want to sign up for, and will have an accurate timeline and an open panel.
FILING AN APPLICATION
We will send you a complete checklist of all information and documents needed to submit applications.
Once we have the details about you, our registration team will continue to submit the relevant contract requests and first make sure that the shipment is error-free, thanks to our extensive experience. As a result of the first time we have submitted the correct request, we are proud to be able to bow down in the fastest transfer time to win the contract.
NEXT APPLICATION
Our team checks the submitted request every two weeks to make sure it has been received.
and is in the payer’s system and that no further information is required and everything is fine. We will always monitor you until the contract is completed and delivered to your physical location.
PROFESSIONS FOR NEAR PANELS
Payers such as UHC, Aetna and BCBS sometimes have closed laboratory panels for a specific area. We will arrange the shipment of a wide range
The profession outlines the key points of your service, including services and details on how to bring exceptional patient care to your area. All these details are included in your business plan and submitted to the representatives of the main provider that pays. Although it can be difficult to reverse a closed panel decision, we have a success rate of 30%. Records OUT OF NETWORK
This is for all providers who choose to stay in the network with some payers. Or if due to closed panels, forced to stay
off the network. Our team helps with network registrations on the left, NPI registrations on the payer’s website and more, so your medical practice is in the payment system and initiates payments in the network.
DEMOGRAPHIC CHANGES
We help with all the basic and complex demographic changes, such as updating the new TAX ID for everyone who pays your payer
mix, update new address, bank accounts, etc. We also help with setting up all ERA and EFT registrations.
ANNUAL MAINTENANCE
Good management of the provider database is essential for larger healthcare facilities with multiple providers. We manage and maintain all of your providers and
doctors’ login details on our login portal. It is a comprehensive, transparent and HIPAA compliant tool that we have specially designed to ensure that we keep your database current and accurate.
PECOS AND CAQH SETUP AND MAINTENANCE
Maintaining the most up-to-date PECOS and CAQH profiles is essential in today’s healthcare environment. Most payers move to the CAQH path of proof letters and register with healthcare providers. We maintain and maintain your CAQH and PECOS profiles and ensure that all your information is properly profiled and meets.
BUSINESS CONTRACT
Not only do we get your contracts, but we also negotiate payments for you. We have a comprehensive database of all the latest payment plans from payers.
We study your competition and this data helps ensure that we get the best rates possible for your procedures so that we can determine the best fees for your medical practice. We will review your old contracts and try to get better fees than those available from the current payer.