Credentialing Solution Questions and Answers
It is not enough to just get claims out the door (billing) anymore, you need to be enrolled with the payers and understand that claims that are not authorized for treatment will not get paid! At RADMAX, our ultimate goal is to maximize our client’s bottom line. We will help you identify unrealized revenue by making sure you are contracted with payers in your area along with local IPA’s. Our success depends upon your success and we WILL get results!
What types of medical practices do you generally handle for credentialing?
- We handle all types of medical specialties. We have a knowledgeable, experienced credentialing staff that has worked in a variety of medical practices and specialties, including both physician (clinic) and hospital environments.
What is provider enrollment?
- Insurance payors require the provider offering services to their patients to be enrolled in their program. RADMAX will enroll you (submission of documents) by providing the required information.
Why do I need someone like RADMAX to do my credentialing?
- Having a great billing department or billing service is not enough anymore and no guarantee you will get paid for your services! With the recent changes in healthcare payers are making it more and more difficult to get paid. You most be enrolled (in-network) to get an authorization for treatment (get paid). The days of out-of-network payment and retro-authorizations are coming to an end. You need a company like RADMAX, who knows credentialing, to expedite the increasing headaches and demands associated with the different payers.
What is involved with the credentialing process?
- RADMAX will gather information on your medical practice and send you an orientation list of all documents and paperwork needed. This can include items such as a copy of your drivers license, medical diploma, internship and residency diplomas, a passport-sized photo, a current CV, your medical license from all states in which you have worked, state and federal controlled substance permits (DPS/DEA), board certificates, life support certificates, and your NPI number and confirmation letter. RADMAX will need this information to submit your applications.
Who do we call if we have a question?
- You can call RADMAX at any time. An Account Manager is assigned to every client and that person is always available to answer your questions.
How long does it take to get credentialed?
- The credentialing process can be a long one and it is definitely tedious! Depending on what is needed, the process can take up to 120 days. Typically though it takes 60 to 90 days.
How long does Medicare enrollment take?
- Medicare enrollment can take up to 120 days but our average is around 55 days from the day the application is received.
Can you accommodate clients outside of Texas (home base)?
- Yes, we are a nationwide company (handle clients throughout the United States). The process is very different for different areas of the country, especially for government programs like Medicaid. Also, RADMAX will research open panels in your specific area and their requirements. This is extremely important for your continued revenue stream.
Why do providers need to be enrolled in more than one states’ Medicaid program?
- Prior to the New Affordable Care Act charges were paid even if you were “out-of-network” with Medicaid. Now however, you will no longer be reimbursed if you are not enrolled in the states for which the patient resides. “This is especially important for boarder state providers.”
WHAT IS CAQH?
- CAQH stands for “The Council for Affordable Quality Healthcare, Inc.” which is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. CAQH’s collects provider information necessary for credentialing, and pulls it together into one central source which is accessible to different insurance carriers.
Do you follow-up with CAQH quarterly attestations?
- Yes, RADMAX maintains and responds to CAQH queries each quarter including your document requirements and updates.
How do I quickly obtain a CAQH ID?
- By using RADMAX you can expedite the process. We do not like to make unrealistic claims, but we have had turnarounds in as little as two days and as long as three weeks.
DO I need a CAQH ID?
- Yes. Almost all insurance companies now require CAQH credentialing as the first step in the insurance enrollment process.
Does CAQH cost money?
- CAQH charges the insurance companies and is free for medical providers. RADMAX is a service that helps providers expedite the process. We do charge for this service.
How much does your services cost?
- Our pricing is based on our workload (costs) and services are structured to best meet the needs of our clients.
Do you follow-up with a client if they are missing information?
- At RADMAX our middle name is Diligence. We will always let you know if there is additional information needed or missing.
How can I track the status of my credentialing?
- RADMAX will provide you the ability to log into a secure web page online to research the status of files being processed. After a roster of records being processed is displayed, you can access any particular record and view full practitioner information including images, confirmation dates, payer enrollment status, and more!
Contact us to learn more about ways we can help you with credentialing.