Provider Enrollment and Credentialing Services
- Initial and Re-Credentialing Applications submission to Managed Care Organizations
- Assist with obtaining NCQA and URAC Credentialing and Network Accreditations
- Credentialing Delegation/Vendor Management
- Creating Credentialing and Re-Credentialing policies
- Credentialing Committee processes
- Commercial Insurance Provider Enrollment: BCBSLA, Humana, United Healthcare, Cigna, etc
- Louisiana Medicaid Enrollment: Aetna, Healthy Blue, Louisiana Healthcare Connections, United HealthCare, AmeriHealth Caritas Louisiana
- Medicare Enrollment
- CAQH Registration: Initial Profile registration and continue quarterly re-attestations
Credentialing Delegation program
As health care systems grow larger more providers are being credentialed with Health Plan Organizations under what is known as Delegated Credentialing/Vendor Management. This is a process where a health plan organization gives authorization to the provider group to perform credentialing in-house. If your organization are looking into participating as Delegated Group with a Health Plan Organization, I can assist you with the complete process. As a former Credentialing Manager, I created the credentialing delegation program for a large managed care organization and have the experience and knowledge of Delegation Credentialing/Vendor Management.
NCQA and URAC Credentialing and Network Accreditation
With experience working with National Committee for Quality Assurance (NCQA) and Utilization Review
Accreditation Commission (URAC) for over 20 years, I will bring my knowledge and best practice experience in the
credentialing, re-credentialing, network management and quality improvements processes.