Provider Enrollment
Provider Initial Enrollment
- Request and collect information by payer plans
- Database file set up for providers
- Enroll provider according to Managed Care Strategy
- Application preparation and submission for each provider
- Periodic tracking of application
- Monthly enrollment status report to provider/client
- Establish CAQH, Georgia Uniform for Applications, and PECOS
Facility Enrollment
- Enrollment of new locations
- Update changes to previous enrollments
- Provide information to Billing Company
Maintenance
- Maintenance of CAQH for appropriate providers
- Reporting changes for location, etc
- Re-credentialing
Medical Staff Services
Hospital Privileging
- New Provider Privileges & NCQA
- Primary Source Verification under Joint Commission standards
- Preparation of Credentialing Information for Hospital Credentialing Committee
Credentialing
