Credentialing and contract analysis, down to every payment.
Most practices learn they were underpaid or out of network after the fact. We keep every surgeon credentialed, keep every payer contract and fee schedule on file, and check every insurance payment against what the contract says it should be. Then we use that data to recover underpayments and negotiate better fee schedules.
Credentialing, managed for every surgeon
- Payer enrollmentCredentialing and re-credentialing with dental and medical insurance payers, with each surgeon’s network status tracked by payer and by office.
- Credentials on fileLicense, DEA, state controlled-substance registration, sedation permit, malpractice, board certification and CPR/ACLS, kept in one document vault for each surgeon.
- Expiration trackingRenewals flagged before they lapse, with 30- and 90-day warnings, so no surgeon falls out of network over a missed date.
- CAQH and NPICAQH profiles and NPI records kept current, the information payers check first.
- Payer applicationsCredentialing applications filled from each surgeon’s record, so the details are consistent across every payer.
- New practices and new surgeonsGroup and facility credentialing for a new practice, and enrollment for every surgeon who joins.
Every payer contract, analyzed
- Contracts and fee schedules on fileEvery signed agreement, amendment and fee schedule organized by office and payer, with effective and renewal dates.
- Network status by payerWhich plans each office is in network with, including leased networks that access your contract through another company.
- One home contract per national carrierNational carriers such as Delta Dental and Blue Cross Blue Shield contract in your home state. We make sure their other state entities pay you under that contract and its fee schedule.
- Missing fee schedules foundPayers paying your practice with no fee schedule on file are flagged, so you know what you are actually contracted to receive.
- Renewals and terminationsContract renewal dates and termination notices tracked, so nothing changes without a decision from you.
Every payment checked against the contract
Every insurance payment is compared code by code with the contracted fee schedule. Payments below the contracted rate are flagged as underpayments, grouped by payer, and worked through appeals with the documentation the payer requires.
Each payer also gets a scorecard: how it pays compared with your other payers for the same procedures, the percentage of the fee schedule it actually pays, its denial rate and top denial reasons, appeals, and how many days it takes to pay.
Fee negotiations backed by your own data
When it is time to negotiate, we bring the numbers: what each payer pays you code by code, how that compares with the other payers in your market, and where the contract falls short. Fee schedules are negotiated with payers on your behalf, and every decision stays yours.
Common questions
What does oral surgery credentialing include?
Enrolling each surgeon with dental and medical insurance payers, re-credentialing on schedule, keeping CAQH and NPI current, and tracking every license, DEA, sedation permit, malpractice policy and certification so nothing lapses.
How long does credentialing with insurance payers take?
It depends on the payer, and some take months. Starting early and submitting complete, consistent applications is the best way to avoid delays, which is why we track every document and expiration date for each surgeon.
What is payer contract analysis?
Comparing what each insurance payer actually pays your practice with what your contract and fee schedule say it should pay, code by code, so underpayments are found and recovered and you know which payers are worth renegotiating.
How do you find underpayments?
Every insurance payment is compared with the contracted rate for that procedure. Payments below the contract are flagged, grouped by payer and worked through appeals.
Do you negotiate fee schedules with insurance companies?
Yes. We negotiate fee schedules with payers on your behalf, using your own payment data and how each payer compares with your other payers.
What is a leased network?
A leased network is when another company rents access to your contract with a payer, so its members are paid at your contracted rates. We track which leased networks reach your contracts.
Is this part of a TEG partnership?
Yes. Credentialing and contract analysis work alongside our billing and collections service, so what we learn from the contracts flows straight into how claims are paid and appealed.
Also included in every partnership
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