Simple Tricks to Avoid Credentialing-Related Denials

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Simple Tricks to Avoid Credentialing-Related
Denials
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Introduction

• Keeping the Medical Practice revenue flow intact
  and evergreen requires constant effort from
  physicians and Medical practices.
• Overcoming financial lags owing to claim denials
  and keeping up with the ongoing changes and
  regular updates are prerequisites for any
  practice to ensure the monthly collections and
  claim reimbursements are intact.

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• There are various reasons why a claim can get
  denied and affect your cash flow, physician
  credentialing is one among them.
• Timely Provider Credentialing and keeping the
  credentialing privileges active are mandatory to
  avoid related claim denials.

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Why is Physician Credentialing Crucial?

• Physician Credentialing is crucial as they affect
  the financial aspect of the Medical Practice or
  the Physician greatly if not valid.
• Without proper credentialing Physicians can not
  send patient claims to the payor.
• Expired or invalid Physician Credentialing can
  lead to claim denial and loss of reimbursement.

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• Until the Medical Practitioners Credentialing
  are complete and active the physician or practice
  might not get their due payments from the
  insurance carrier.
• Lack of proper Credentialing or Active
  Credentialed status is equivalent to
  non-participating or Out- of Network providers.
  
• Therefore it is of paramount importance for the
  Physicians to be in the network with active
  credentials to ensure they are linked to all the
  payors whom they would like to bill for.

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Tricks to Avoid Credentialing Related Denials

• Do a complete audit of your denials to analyze if
  the lack of proper provider credentialing is a
  reason. If yes, then take adequate steps to fix
  them at once before it affects your bottom line.
• Keep a checklist of all the payors you are
  in-network with or credentialed with and have a
  streamlined approach to have them checked and
  re-credentialed on time.

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• Set reminders to notify ahead on Re-credentialing
  requirements so you have ample time to get the
  required supporting document for application and
  submission on time.
• Keep your CAQH profile up to date always making
  any changes or updates as and when required

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• Physicians getting first-time credentialed with a
  payor should be well prepared with all required
  documents to be submitted along with the
  application for on-time processing and
  enrollment.
• Incomplete and inadequate information or
  documents can lead to unnecessary delays and
  affect claims reimbursement

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• Investing and leveraging on credentialing
  software can reduce human errors and delays.
  Medical groups or practices needing frequent
  credentialing support  rely on these upgraded
  technologies to pace up.
• Outsourcing to Credentialing Professionals
  of Medical Billing Companies with an expert team
  on Physician Credentialing is the most lucrative
  method.

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Benefits of Outsourcing Provider Credentialing

• Access to top Physician Credentialing experts
• Effective and Efficient processing of each and
  every credentialing application with utmost care
  to ensure they are clean and clear on the first
  submission to avoid unwanted delays and hassles.
• Cost-effective and Stress- free

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• On-time Credentialing and Re-credentialing to
  ensure your payments are intact and unaffected
  avoiding claim denials due to lack of
  credentialing requirements.
• Time advantage and Advanced Support yield more
  scope for patient care
• Upgraded tools and technologies processing your
  Credentialing application proficiently.
• CAQH updating and Re-credentialing reminders and
  Support
• Reduces Claim denials due to lack of Provider
  Credentials

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About MGSI

• MGSI is a national Medical Billing and Revenue
  Cycle Management Service provider located in
  Tampa, FL.
• With over 27yrs in the Healthcare Industry MGSI
  provides various scopes of services right from
  End to end billing services and other services
  like Physician Credentialing, Practice
  Management, Healthcare Contracting, etc.

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• MGSI has expertise in handling credentialing
  Services with different payers and our Physician
  Credentialing team are experts in handling each
  application adequately to meet the elected
  insurance carriers requirements.
• To know more about MGSI and our services, call
  1-877-896-6474 or log on to www.mgsionline.com

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