Credentialing & Contracting Services

Credentialing and Enrollment

Effective Credentialing and Enrollment is frequently the missing key to successful revenue cycle management.  While many organizations/practices work towards making improvements to their billing departments and/or hire billing experts, credentialing and enrollment is frequently the piece given little attention within an organization/practice.  With a small investment in credentialing and enrollment, frequently the return on the investment can yield higher margins.

InteCare takes care of your credentialing and enrollment needs and acts as your credentialing department.  No matter what the size of your organization/practice, InteCare’s expert credentialing specialists can ensure, your clinicians are enrolled with each of your payors in order to maximize your revenue.

  • Initial enrollment with all payors, Medicaid and Medicaid Managed Care Organizations, Medicare and other Medicare Insurance, and all commercial insurers.
  • Maintain credentialing requirements for each licensed providers throughout the year, including CAQH
  • Re-credentialing
  • Facility Credentialing and Re-credentialing

Primary Source Verification (PSV)

If you are a facility, health plan, ACO or other entity requiring primary source verification, InteCare can include primary source verification and can even provide full credentialing through the InteCare Credentialing Committee if needed.  We follow NCQA standards for all primary source verification.

  • Initial and re-credentialing/re-privileging
  • Verify state licensure
  • Verify DEA/controlled substances
  • Verify Transcripts and Residencies
  • Monitor disciplinary actions federally through the Office of Inspector General (OIG) as well as licensure boards of every state.

Payor Market and Reimbursement (Contracting)

InteCare understands that organizations may have a vast array of needs when it comes to contracting.  From expanding your payor mix or payor market by obtaining contracts from new payors to developing strategic organizational initiatives around contract management and payment analysis, InteCare listens and customizes the contracting experience to meet your specific needs.

InteCare has contracting experts who have worked for both the provider organizations as well as the insurance payors.  This knowledge and expertise can assist provider organizations/practices with understanding how to navigate the insurance world at C-level leadership relationships.

Finally, InteCare’s C-level expertise is able to facilitate and assist the leadership in moving to value based care contracting and build value based care programs and other health care cost savings initiatives with payors.

  • Working alongside organizations to resolve reimbursement issues with current payors
  • Expanding your payors by obtaining new contracts
  • Evaluating your current contracts in regards to revenue and services
  • Reviewing and negotiating contract language and rates
  • Developing and managing special payor value based care and cost of care savings initiatives
  • Building payor relationships

Building Networks for Health Plans, ACO’s or Other Network Entities

As Preferred Provider Networks and Specialty Networks have become more and more important in the health care industry, InteCare is able to assist with guiding and developing comprehensive networks of providers.  Our experts are able to build a network of providers fast and efficiently and can operate as your network and provider relations department while also credentialing and enrolling all providers using NCQA standards.

  • Send and obtain contracts efficiently, including facility contracting
  • Negotiate contracts with Providers as desired
  • Obtain necessary contract documents from Providers
  • Build Provider Directories and Geo-Access Reports
  • Call Center Provider Relations
  • Publish Provider Manuals
  • Organizational/Facility Credentialing
  • Individual/Provider Credentialing and Paneling

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