An area of significant financial risk is that of Provider Enrollment with the Managed Care organizations. Therefore, SHP has automated the Provider Enrollment service by speeding up delivery with accurate, signature-ready documents. In other words, our established relationships with various payers gives us the inside edge to meet payer Provider Enrollment requirements quickly and correctly the first time. Additionally, we track the documents from submission through the approval process, communicating participation status regularly with our clients.
Initial Provider Enrollment
Clients who employ physicians, add new physician locations, or add new service lines may require payer notification or application. To that end, SHP will:
- Request and collect information from clients and its individual providers.
- Database file set up for providers in order to generate accurate, professional documents.
- Additionally, enroll provider according to the client’s established Managed Care Strategy.
- Application preparation and submission for each provider and each payer plan.
- Periodic tracking of application through the approval process.
- Meanwhile providing monthly enrollment status report to provider/client
- Establish CAQH, NPI’s, Georgia Uniform for Applications, and PECOS, as client desires.
- Enrollment of new service locations as required by payers.
- Update changes to previous enrollments
- Provide information to client’s business office or billing vendor.
- Maintenance of CAQH for appropriate providers
- Reporting changes for location, etc
- Process re-credentialing applications as required by payers.
Medical Staff Services
- SHP serves as our client’s outsourced medical staff office. In brief, performing primary source verification services.
Contact us to learn more and receive a quote.