Expert Contracting & Credentialing Explained

Expanding a healthcare provider’s network is essential for delivering comprehensive patient care. Delaine Henry, CEO of Advanced Revenue Cycle Management, explains the important processes of payer contracting and credentialing, especially for home health, hospice and palliative care programs.

The Dual Facets of Contracting and Credentialing

Contracting and credentialing are two key steps that healthcare providers must navigate. Payer contracting means getting healthcare providers included in the networks of specific payers. This can be challenging because some payer networks are geographically restricted. For example, a network might accept providers in Texas but not in other states. These geographical limits require careful planning to ensure providers can join the networks they want.

Credentialing, on the other hand, involves verifying the qualifications and professional backgrounds of healthcare providers like doctors and nurse practitioners. This ensures we meet the standards set by payers. For instance, in palliative care, a program might have a contract with a payer, but each provider within that program also needs to be credentialed. This creates a double layer of requirements, both for the practice and the individual providers.

Tackling Geographic and Policy Barriers

Our team of contracting and credentialing specialists helps providers navigate these hurdles. They assist in overcoming geographic and policy barriers to secure network participation and favorable payment terms. Some payers have straightforward processes, while others are more complex. Our specialists manage these variations, ensuring providers’ needs are met efficiently.

Ensuring Best Terms and Payments

By offering support in contracting and credentialing, we allow healthcare providers to focus on patient care without getting bogged down by administrative tasks. The aim is to secure the best possible terms and payments for services, improving the efficiency and profitability of healthcare practices.

Contracting and credentialing are essential for healthcare providers looking to expand their network. With Advanced Revenue’s expertise, navigating these processes becomes easier, helping providers achieve their goals and deliver better patient care.