Medical Practice Credentialing

Since 2007 Reliable Practice Consultants Corp. has tailored its services for your practice and your long term financial wellness. Whether you are a startup practice or a seasoned facility, credentialing is a crucial element for your medial practice. Credentialing is complicated and can be a painstaking process.

Reliable Practice Consultants Corp. medical credentialing specialists want to relieve you of that headache! We provide a service to help you get set up quickly, accurately, as well as maintaining your credentials so your business can maximize the number of potential insurers.

Trust the experts at Reliable for with all your credential needs, such as adding/removing a provider, Contract status research, Insurance payer applications, Medicare re-validations, Medicaid re-enrollments, privileges/re-appointment, Address updates; Bank updates, and Credentialing maintenance. Our team is prompt and do everything in our power to work with the payer — and their application processing.

Experience counts! The team at Reliable pays close attention to the details. We go the extra mile to ensure that all critical information is accurately processed. Our goal is to limit the problems and avoid delays. We are current with The Coalition for Affordable Quality Healthcare (CAQH). Physicians and incoming physicians who regularly update and attest with CAQH find credentialing and re-credentialing much easier. We also know your . As you may be aware several states have their own laws for timely credentialing, including reciprocity regulations and in-state credentialing.

Credentialing is tedious, but the team at Reliable Practice Consultation strives to make life easier.

Medical Practice Credentialing

Medical Credentialing Services

Whether you are a solo practitioner or a group practice, regardless of size the Reliable Practice Consultants Corp. will gladly handle your claim preparation. The process of preparing a claim is very important for the financial wellness of your medical practice. Preparing a claim requires meticulous and accurate details from the patient visit. The claim is prepared for electronically submission and sent to the clearinghouse. Here it is checked for errors after which the claim is sent to the payer. Inaccurate or improper reporting could result in a physician not being reimbursed appropriately.

Claim preparation begins after the healthcare provider treats a patient. Based on the procedure and the diagnosis, the Healthcare providers completes the patient documentation. The team at Reliable will review each patients ICD-10 and CPT Codes, apply the proper modifiers, and submit the accurate claim for payment. After the claim has been evaluated, the insurance company must provide both the patient and healthcare provider with an Explanation of Benefits (EOB). The EOB breaks down the adjudication process, showing the dates of service, procedures and charges, patient financial responsibility, and the amount paid to the healthcare provider. There are a number of technical protocols and industry standards must be met for insurance claims to be delivered expediently and accurately between medical practice and payer.

The team at Reliable Practice Consultants Corp will record patient data, submitting primary/secondary/tertiary claims, and submit them to the appropriate party. The insurance claims process can be complex. Fortunately, the professionals at Reliable have the tools and the know how to help complete insurance claims on a day-to-day basis. We are well versed with the industry standards, individual insurance company regulations, clearinghouse procedures, and the adjudication process.

Our goal is to simplify the medical billing process and improve efficiency to ultimately increase revenues for our clients.

Update CAQH

Electronic Claim Submission

As you may be aware, the past few years in the healthcare industry has undergone some dramatic changes. Due to the High-Deductible Health Plans (HDHPs) and reducing benefit coverages are making many practices rethink collections and electronic claim submission.

Due to HDHPs payers and employer’s patients will bear more of the financial burden for their health care, it will be harder to collect these larger amounts. Providers should expect to re-evaluate how their offices are run to improve collections from patients. Now more than ever, Reliable Practice Consulting Corps is your outsource billing solution.

The proportion of insurance claims submitted to insurance providers electronically has more than tripled in the last decade. The reason is simply… Experienced medical billers and coder can effectively manage the entire electronic claim submission process. The team at Reliable Practice Consultants Corp. will submit these files correctly, and adequately and help limit pending claiming. We utilize the most cutting edge technologies available to get claims paid and to fight claim denials. Ultimately your practice will reduce administrative costs, significantly speed up payments, and increase cash flow for your practice. Submitting claims electronically may allow health care providers to decrease administrative costs and improve cash flow.

Paper Claim Submission

Reliable Practice Consultants Corp will handle your paper claim submission. We have invested in an in-house Practice Management software that allows us to convert your paper charts into electronic claims. There are a hand full of insurers that only accept paper claims. We know which insurers require paper and will print them out to physically mail them to these payers. Our Certified Professional Coder will process your claims accurately and promptly. Whether your practice uses the CMS-1500 or the UB-04 form, our staff is more than capable of managing your paper claim submissions. With our expertise you can count on us to be efficient and accurate which will save your practice time and money.

Deadline Reminders

Electronic Data Interchange (EDI) Management

We’ve gone paperless! Most medical facilities are becoming increasingly digitized. In the new era of the paperless office, it is not uncommon for all kinds of data to be transferred electronically rather than on paper. The healthcare industry is at the forefront of this trend. When it comes to filing insurance, and all your clients sensitive information we use Electronic Data Interchange (EDI).

The team at Reliable Practice Consultants Corp understand the importance of EDI (Electronic Data Interchange) and the role that EDI has in the future. The reason that EDI has become especially important for insurance claim documentation is because of the reliability and increased efficiency seen with the use of electronic attachments. When supporting documentation is included along with an initial electronic claims submission, both healthcare providers and payers can the benefits, such as fewer denials, edited requests, quicker returns, and increase in ROI.

The team at Reliable uses the Electronic Data Interchange because EDI follows HIPAA regulations and ANSI standards. Our team will manage the EDI process for all your medical records, bills, claims and etc.

Patient Statement

At Reliable we provide you a service for all your medical billing. We act as your back office for your financing wellness. We will gather, organize and send your patient statements. Any practice will tell you that patient statements are often tedious and evasive. However, with the team at Reliable Practice Consultant Corp we can help reduce cost and save time for your practice by managing your patient statements.

Need to complete:

Current with Insurance Companies

Payment Posting Will Occur Through Two Main Processes

Electronic Remittance Advices (eRA’s) are the preferred method; these 835 5010 files will be setup during our initial review of your clinic through the clearinghouse, for efficiency. Some payers do not allow for eRA; those payments and EOB’s will be sent directly to your clinic with a paper check to be deposited. Your team will share these documents on a regular basis with Reliable to ensure accurate reporting of your financials. We will also confirm Electronic Funds Transfer with each of the payers that provide EFT, so that your funds are deposited directly and promptly into your bank. Your month-end reports will reflect all financial processing that occurred throughout the previous month.

Accounts Receivable Management

Reliable will simplify and automate your clinic revenue cycle management process. Increasing your collections while reducing denials, underpayments and lost or ignored claims is part of the work we do at Reliable in order to maximize your income. We work with the Practice Management tools to work claims, denials, appeals, etc. Upon initial review, we will trend any clinic issues you may have had in the past, isolating payer denials and no-response claims, giving you immediate visibility into the status of claims across your organization.

Denial Management

Claims are processed and submitted promptly by Reliable. We have a zero-tolerance policy for unpaid claims. Part of the initial review of your clinic includes creation of web-based tools to ensure transparency to payers, where available. If there are any denials, they will be reviewed and reworked immediately through the online tools created by Reliable. If there is more complexity to a denial, an appeal or phone interaction may be required; rest assured that your Reliable team will manage this process closely and to completion.

Payment posting

Reporting

Reliable reports are quite comprehensive, and quickly readable, so that you may capture your practice financials in a snapshot. We will prepare and deliver to Client practice analysis management reports a month-end. These reports will reflect financial details of the practice throughout the previous month. We meet with you to review and ensure comprehensive knowledge of your practice financials at your convenience, whether that be monthly, quarterly or annually.

Patient Service

Patients will receive statements once all their insurance has been processed (primary, secondary and tertiary). Each patient statement will reflect your practice name and address, with our phone number. All patient calls relating to their statements will be directed to our call center and responded to in a polite, efficient and courteous manner.

Better billing and collections not only saves practices money and adds to their revenue, but it allows medical practices to focus more time on what they do best – care for patients.

Reporting

Package 1

$1350 Without Billing Service

$650

  • 5 Payers of Your Choice
  • Includes CAQH
Add to Cart

Package 2

$2600 Without Billing Service

$1,300

  • 10 Payers of Your Choice
  • Includes CAQH
Add to Cart

A La Carte

$300 Without Billing Service

$150

  • Add Less the 5 Insurance
Add to Cart