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Gain efficiencyCredentialing

Improving the business of healthcare

Credentialing and enrollment are critical components that ensure your providers are employable and ready to bill for services, and that patients will be treated by competent and legitimate practitioners. The process of enrolling with health plans, however, has grown in complexity and is very time and resource intensive, and implementing expedient and effective privileging processes continues to challenge healthcare entities.

BerryDunn’s experts are adept at navigating these challenges. As an NCQA-certified CVO (Credentials Verification Organization), we assist our clients by streamlining the process with strict adherence to compliance policies. We provide:

  • Process improvement assessments for Medical Staff Offices (MSO)
  • Primary Source Verification (PSV) services
  • CVO services for delegated commercial payer agreements
  • Continuous monitoring of state and federal exclusion lists, as well as license suspensions or malpractice settlements
  • Outsourced MSO services
  • Ongoing monitoring services for NPDB, SAM and exclusion lists (Federal and State)

We offer a full array of credentialing and enrollment services to help you improve efficiency and maintain compliance. From application completion to ongoing sanctions monitoring, we have scalable solutions for all types of organizations. We process enrollments for both practitioners and facilities, including health plans, hospitals, FQHCs, medical groups, laboratories, and other healthcare entities. 

  • Initial applications and revalidations of government payers
  • Credentialing and enrollment coordination with regional and national PPOs and IPAs
  • Set up and maintenance of CAQH profiles
  • Credentialing and enrollment in commercial health plans
  • Payer contract evaluation and negotiation
  • NPI registration and PECOS setup/maintenance
  • Exclusions and sanctions monitoring
  • Credentialing consulting

BerryDunn has joined forces with the VantagePoint Healthcare Compliance and Credentialing team to expand the services we provide to healthcare organizations. Contact us to learn more about our credentialing and related services.

  • Reimbursement issues
  • Managed care contracting issues
  • Hospital privilege applications and reappointments
  • DEA registration
  • Medical license application processing and tracking

Exclusion and sanctions monitoring
BerryDunn helps clients keep providers actively enrolled with payers and ensure their credentialing documentation is current. Appropriate management is particularly important for organizations employing per diem staff based upon the provider working for multiple organizations. Our clients benefit from our high-value, high-touch approach to monitoring for expiring licenses, Drug Enforcement Administration (DEA) or Controlled Dangerous Substances (CDS) registration, board certification(s), and professional liability insurance.

We encourage clients to maintain an ongoing exclusion and sanctions monitoring regimen. From the OIG exclusion list, to System for Award Management (SAM) and State Medicaid sanctions monitoring, BerryDunn can take care of this important compliance obligation on behalf of our healthcare credentialing clients.

Primary Source Verification (PSV) 
Achieving CVO certification from NCQA demonstrates that we have the systems, processes, and personnel in place to thoroughly and accurately verify your providers’ credentials. As a fully certified NCQA-certified CVO, we are trained in performing primary source verification according to stringent NCQA standards.

Payer contract evaluation and negotiation services
BerryDunn can assist physician practices, facilities, or any new healthcare business in negotiating their contracts with commercial payers. We can also help with contract re-negotiations and evaluation of current insurance contracts.

Our contract evaluation and re-negotiation service for established healthcare providers and organizations includes:

  • Review and analyze current agreements
  • Evaluate payer agreements and compare to regional market standards
  • Propose a contracting strategy based on business goals and current insurance climate
  • Determine whether capitation, exclusivity, preferred provider status, or pay-for-performance is available with any payers
  • Develop and implement a plan to renegotiate current insurance agreements

Credentialing consulting 
We assist healthcare organizations in selecting the right approach to meet their credentialing and enrollment needs, including insourcing previously outsourced services, full or partial outsourcing, accreditation, and delegated agreements. Organizations often need temporary support for:

  • New credentialing department set-up
  • Post-transaction assistance
  • Policy and procedure development
  • Project management for full or partial outsourcing transitions
  • Establishing a credentialing committee
  • Improving existing credentialing department operations

Through our first-hand experience as an NCQA-certified CVO providing credentialing and enrollment services (certified for 11 out of 11 verification services) for clients across the continuum of care, and our deep bench of compliance and revenue cycle consulting expertise, we offer a complete array of credentialing consulting services to meet your needs. 

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As an NCQA-certified Credentials Verification Organization (CVO), we assist our clients by streamlining the process with strict adherence to compliance policies.

Achieving CVO certification from NCQA demonstrates that we have the systems, processes, and personnel in place to thoroughly and accurately verify your providers’ credentials.

We're certified
Learn more about what it means for you