Delegated credentialing and Primoris Credentialing Network have expanded into the Missouri market. The largest credentialing IPA in the Midwest is now credentialing providers in the Show-Me State.
The Missouri expansion was made possible via the cooperation of Anders CPA + Advisors, a trusted partner of Primoris, and the Fifth Avenue Healthcare Services family of companies that include 5ACVO and Fifth Avenue Agency. Anders CPA + Advisors provides advisory, audit, assurance, and tax services to businesses of all sizes. Anders CPA + Advisors can help providers acquire their licenses after completing the credentialing and provider enrollment processes, two complex series of tasks Primoris can effortlessly perform.
Primoris Credentialing Network has a comprehensive history of providing unparalleled credentialing solutions to providers in Missouri, Oklahoma, and neighboring regions. The provider enrollment experts offer 54+ health plan and network enrollment options, with many more on the way.
What Does Delegated Credentialing Mean For Our Providers?
Delegated credentialing for Missouri is the smarter way to complete credentialing. Primoris has delegated contracts with payors and networks across Missouri, Illinois, and Oklahoma, providing credentialing services to 1000s of providers across the United States.
Delegated credentialing lets us use one application to add a provider to multiple health plans and networks. The time we save providers can equate to increased revenue. We can complete delegated credentialing in approximately 15 days, 75 days faster than the industry average of 90 to 120 days. This equals up to $707,954 in new billing opportunities.
Delegated credentialing Missouri payors currently include:
- Friday Health Plans offers simple and affordable plans for people who buy health insurance.
- Humana: one of the largest health insurance issuers in the United States.
- MultiPlan: a healthcare cost management company.
- Prime Health Services: offers healthcare cost containment and medical management services to the group health, workers’ compensation, corrections, and auto liability markets.
- USA Managed Care Organization: the country’s largest privately-held Preferred Provider Organization.
- WellFirst Health: combines physician, hospital, and health plan solutions to cut costs and improve care quality.
- Zelis: connects payors, providers, and consumers with data-driven ideas.
We are working towards making all Missouri plans eligible for Primoris delegated credentialing. We look forward to working with Aetna, American Health Advantage of Missouri, United Healthcare, and 17 other plans soon.
5 High Marks Of Credentialing Administrative Simplicity
Delegated credentialing with Primoris comes with administrative simplicity to help our providers start seeing patients sooner and billing faster than the industry average. This bonus feature allows us to provide quicker, inexpensive, and better provider enrollment via:
- ONE Provider Enrollment Application: Delegated contracts allow us to use one application to add a provider to multiple health plans. This method can be much faster than sending an application to each option. We pride ourselves on being the one company that can give this superior customer service.
- ONE Point of Contact: We strive to keep provider enrollment as simple as possible. It makes everyone’s job easier. We offer our providers a single point of contact for their credentialing and provider enrollment demands. Providers and administrators only need to remember one email address or one phone number to get help.
- ONE Experienced Provider Enrollment Team: Our remarkable team is the secret to our success. Our team has become the largest credentialing IPA network in the Midwest because of its 385+ years of combined industry experience. Their expertise has been the key ingredient in developing and perfecting the enrollment process, which they continually work on.
- ONE Delegated Credentialing Web Portal: An easy-to-use, secure credentialing web portal should offer users flexibility—easy access to all provider’s credentialing data files. With one login to enjoy the benefits of organized and accessible data, providers can access their credentialing information whenever they want. Providers can even give multiple administrators unique logins with custom permissions.
- ONE Secure Credentialing Ecosystem: People want to do business with companies they trust. With data privacy being a dominant subject in global news, people worry about who has access to their information and how it can be exploited. We can alleviate our providers’ concerns by giving them a secure ecosystem where their data lives. Providers do not have to worry about locking file cabinets or securing loose paperwork. Each piece of our providers’ data is logged and stored in our system.
- A Better Provider Enrollment Budget: When you use Primoris, your credentialing costs become fixed. You can avoid hidden or confusing fees. Fixed, flat costs can help you and providers across the nation mitigate and sometimes eliminate ongoing financial concerns around new employee training and staff turnover. Our services can benefit nearly any budget size.
A Closer Look into Delegated Credentialing
According to the National Practitioner Data Bank, “delegated credentialing occurs when a health care entity gives another health care entity the authority to credential its health care practitioners.”
Delegated credentialing is a powerful method to get providers to work faster so they can begin billing.
Through delegated credentialing, the process can:
- Demonstrate a greater level of accuracy and oversight than other credentialing operations.
- Expedite reimbursements from payors.
- Increase provider satisfaction.
- Reduce resources (such as labor and office supplies).
- Reduce the turnaround time for network participation.
Delegated Provider Enrollment Health Plan And Network Options
Although we also work with nondelegated contracts, delegated contracts let us enroll a provider in health plans faster than the conventional sending an application to each plan. Primoris has 54+ health plans and network options, with some two dozen available through delegated credentialing. Among our many delegated health plan provider enrollment options are the following:
- Access Health Services: provides administrative services to Medicare Advantage special needs plans, Medicaid support companies, non-governmental health plans, and more.
- Careworks: creates positive outcomes for injured workers through coordinated solutions.
- Evolutions Healthcare Systems: one of the country’s largest independently-owned PPO networks.
- First Health: a leading national network that promotes simple implementation and administration.
- Fortified Provider Network: a direct-contracted preferred provider network.
- Galaxy Health Network: a directly contracted managed care provider network.
- Generations Healthcare Network: provider nursing and rehabilitation services.
- And More
Nondelegated Health Plan And Network Provider Enrollment Options
We confidently perform all the administrative and functional duties related to completing delegated and nondelegated contract work. Our lengthy relationships with our nondelegated health plans and networks can speed up credentialing and provider enrollment. We gladly work with the following:
- Assured Benefits Administrators: offers self-funded health plans.
- BlueCross BlueShield of Oklahoma: the only statewide customer-owned health insurer in Oklahoma.
- Cigna: a global health service company.
- CommunityCare: offers high-quality, cost-effective health care management services.
- Corporate Remedies: dedicated to enhancing the quality of care injured workers receive.
- Corvel: provides risk management solutions for the workers’ compensation, auto, health, and disability management industries.
- HealthChoice: provides comprehensive health and dental benefits.
- And More
Delegated and nondelegated audits
Much work goes into adding health plan and network options to our growing collection. Our team must pass rigorous audits once every time we want to enter and renew a contractual relationship. Suppose a company like ours has a delegation agreement with a private healthcare insurer or government payor for primary source verification or provider enrollment. In that case, we can expect to receive and pass a delegated oversight audit each year. These audits help ensure that providers are being correctly credentialed.
Poor credentialing can result in the following:
- Providers with histories of malpractice are allowed to treat patients.
- Providers are being denied enrollment despite having no history of negligence.
These audits assess how well we comply with payor and accreditor regulations by looking at our:
- Adherence to certifying body standards.
- Data management technology security.
- Information handling policies and procedures.
- Roster quality and accuracy.
In December 2021, we passed a HealthSmart audit when we scored 100% in every area evaluated. In March 2022, a MultiPlan audit found our policies and procedures met all the requirements for credentialing, credentialing, appeals, ongoing monitoring, provider rights, and system controls. Audits, while challenging, allow us to provide peace of mind to our providers and payers, all knowing that we are working at the highest levels of excellence for our providers and patients. In addition to audits being a valuable tool for our providers and clients, our credentialing web portal is another helpful tool, promoting efficiency and excellence.
Credentialing Web Portal
We acknowledge the need for robust data privacy and protection in the healthcare industry. Cybersecurity policies can do more than protect our professional reputation and the data we collect. They can influence whether or not providers will partner with us for credentialing and provider enrollment.
In addition to guarding data against threats and attacks, we want our providers to feel that we honor their rights to data security. All personal information is sensitive. As such, we have taken steps to protect provider data so they can rest easy knowing we respect their wishes. We hope our Delegated Credentialing Web Portal exceeds expectations.
Built with security in mind, our web portal lets you:
- Track Everything: You can use our efficient web portal to track everything like health plan enrollment, current status and updates, credentialing files in progress, reappointment filings, historical files, expiring documents, and committee dates.
- Customize Everything: You can personalize logins for administrators with health plan participation status and credentialing data. You can use the portal as you see fit.
- Report Everything: All reports can be customized. You can report all files processed as well as historical rosters and expirables.
- Access Everything: The easy-to-use portal lets you access all your information, such as providers’ credentialing progress, the group’s health plan enrollment status, sent and received applications, and historical and current rosters.
- Control Everything: All of your data is within your reach. You can use the secure portal to update rosters, change health plan enrollment requests, order new files, cancel files, and update applications.
- Save Everything: You can upload and save your documents in your customized e-filing cabinet, reducing the amount of physical paperwork that hits your desk.
- Enjoy Easy Accessibility and Functionality: Providers and administrators rely on speed, accessibility, and control regarding enrollment. Our web portal grants them complete visibility of the process. They can now know whether or not their applications were submitted or who can sign into their account.
The web portal offers an often-overlooked reward. Providers and their practices can reduce the amount of paper they usually use, save money on supplies, and ensure that the provider enrollment process continues unhampered by lost or damaged documents. Physical paperwork can go missing, and one spilled coffee mug can destroy the completed application stack on your desk.
How long will it take you to replace and redo all the paperwork? How much longer will provider enrollment take when you cannot find something sitting on your desk a moment ago?
Provider data and activity will rest in our cloud-based ecosystem, which you can access anytime and anywhere on any device. You can review, download, and email what you need whenever you want.
Conclusion: Primoris Is The Delegated Credentialing Solution
Healthcare providers can find themselves extremely busy. In addition to treating patients, they must keep up with industry updates to offer the highest level of care. They only have a little time to fill out numerous applications so they can enroll in multiple health plans. They could be wasting time by enrolling the old-fashioned way. Providers can take command of their health plan enrollment and build revenue faster.
We want providers and administrators to join us as we ride a wave of momentum into the future. Entering the Missouri market is a feather in anyone’s cap, but we will not settle for this accomplishment. When enrolling in health plans and networks, we want to be the only delegated credentialing solution you can think of.
Our health plan and network enrollment options, credentialing administrative simplicity, and credentialing web portal can change how you experience provider enrollment.
More information about Primoris Credentialing Network
Primoris Credentialing Network is an NCQA Credentialing Accredited company specializing in credentialing and provider enrollment. It offers 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
This article was initially published by Primoris Credentialing Network here. For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
