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Credentialing

Credentialing and Re-credentialing

Free yourself of all the headaches, piles of paperwork, and chaos with the insurance companies! Trust the experts at Bijou Health to help you navigate the complex provider enrollment and medical credentialing process at a low cost! 

 

One of the essential components of running a practice is to get and remain credentialed. Without proper enrollment, the insurance company may delay or deny reimbursement, even if the physician provides competent and medically necessary services. Not getting the credentialing process could result in thousands of lost revenue. Trust our experts to handle the complicated process of provider enrollment and national medical credentialing services, allowing you to focus on your patients, and avoid stacks of paperwork and the frustration of dealing with the insurance companies. Every application is managed by a dedicated specialist with knowledge in your area of practice and payer network. Comprehensive application management requires extensive tracking and reporting, providing detailed follow-up, outstanding communication, and Payer feedback. In addition to our enrollment services, we also offer contract consulting, evaluation, and negotiation to ensure you understand precisely how and if your claims are paid according to your Payer agreement. Our standard operating procedure is to conduct a complete contract evaluation before initiating any contract negotiation project. We like to guarantee that our negotiation services will obtain a substantial increase in your reimbursement, justifying the expense. This simple fact is that your practice could be leaving up to 25% of your collections on the table. In the market today, that could be the difference between a thriving business and closing your practice. Bijou Health is a full-service, national practice operations consulting firm entirely based in the United States. 

Our Credentialing Services Include:

Data Collections & Application Submission

We help your practice gather the necessary background and demographic information. Ensure accuracy before submitting the applications to the payers.

Vital Follow-Ups
 

Our medical billing and credentialing services ensure that all follow-ups are performed adequately for a smooth enrollment.

Dedicated Team
 

We provide a dedicated account manager, the sole point of contact well versed in everything about the credentialing for your organization.

Portal Registrations
 

Create and manage CAQH, NPPES & PECOS credentialing portals.

Compliance
 

Our credentialing services ensure compliance with all regulatory agencies applicable to your practice. 

Contracting Issues  & Data Integrity

We resolve contracting issues and maintain data integrity through audits

Primary Source Verification Services

Bijou Health manages credentialing processes in every aspect. In addition to our credentialing services, we offer Credentials Verification Organization (CVO) services. We will design a verification package custom to your needs whether you are a health system, hospital, or provider group. We follow regulatory agencies' guidelines for verification processes and are registered agents with the National Practitioner Data Bank (NPDB). Ask about our NCQA and Joint Commission accreditation package.

Credentialing Maintenance Plan

Maintenance and monitoring are an essential part of the credentialing life cycle. When providers' credentials are not maintained, causing a lapse or expiration, they may be deactivated by payers. When deactivation happens, claims get rejected or denied. Bijou Health will keep you apprised and current with all your credentialing deadlines with a custom maintenance monitoring program that works with your credentialing policies. Our custom reports include an immediate alert of any provider identified as a match from any of the multiple required sanction publications monitored, along with detailed monthly sanction summary reports, for compliance purposes.

Our maintenance plan includes submission of government revalidations, hospital re-appointment applications, insurance re-credentialing applications, and network directory updates. We also offer ongoing CAQH profile management, including re-attestations, to ensure the profile is active and available.

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