Medical Credentialing, Medical Group Contracting & A/R Audits


 Medical Credentialing

       Medical Contracting

Simplicity Credentialing will request and complete payer contracts, provide a rate analysis, review the contract language, to ensure the contract benefits our client. We'll work at negotiating your contracts, for higher reimbursement rates and request any amendments, or carve-outs needed.

The final reimbursement acceptance rate, will be the decision of the authorized official of the group. Please note the contracting process may take from 3-6 months or longer, which is based on the payer processing time line.

Without proper credentialing, payers may deny your medical claims, or insurance payers will process claims as out of network, or non participating. A major step in credentialing is ensuring all providers of the group have an updated CAQH file. We complete this step for our clients, submit the credentialing applications, and notify the payer to electronically pull the CAQH file. Credentialing then begins with the payer . The applications are continuously followed-up with the payer, until the applications are approved. Please note, the credentialing timeline may be less than one month, or up to 3-4 months, which is based on the payer processing time line.

           Medical A/R Audits

Simplicity Credentialing has extensive medical billing and coding experience.

Our A/R Audit process consists of reviewing the proper use of CPT Codes, HCPCS Codes , the correct usage of Modifiers, NDC (Medication) billing and a thorough analysis of claim adjustments.

We'll provide an in-depth analysis, of what's causing your net revenue to decline.