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CVO & Compliance
Work smarter not harder. Let us show you how. From private practice to corporate health care organizations, Catalyst helps you maximize operational efficiency and optimize profitability.
Our Credentialing & Contracting Services Include:
  • New Provider Credentialing, Privileging & Contracting
    Commercial Insurance Plan Provider Enrollment and Credentialing
    Medicare and Medicaid Provider Enrollment and Credentialing
    Medicare Revalidation
    CAQH Registration and Maintenance
    NPI Registration

  • Ongoing Credentialing, Privileging & Contract Maintenance

  • Fee Schedule & Billed Charges Analysis


Contracts are the backbone of medical and dental organizations because they provide access to patients and are the vehicle for your practice income. The process of establishing and maintaining payer reimbursement contracts requires experience, relationships, and knowledge to navigate the system.


Catalyst employs an expert team of specialists in contract procurement, evaluation, negotiation, compliance, credentialing and payment auditing. Our team becomes your outsourced managed care department. Catalyst strives to maintain strong relationships with payers at local, regional and national levels.

The Credentialing and Contracting Process

Credentialing is the process by which insurance carriers, facilities, and hospitals verify that a medical provider meets various quality and regulatory standards. Entities do this by reviewing items such as an applicant’s education, medical licensure, state and federal registrations and certifications, professional liability coverage, as well as many other documents. This time-consuming task requires precise attention to detail and follow through.


Catalyst Consulting works with providers to determine which insurance carriers and networks you would like to pursue participation status with. These carriers may include Medicare, Medicaid, commercial carriers and workman’s compensation carriers. Additionally, we apply for or update your CAQH database. Our credentialing specialist completes the applications for you and continues to track the status of your applications until you are loaded in the carriers’ databases. We provide ongoing updates to you and your staff throughout this process. All of your documents are maintained on our secure database. Your credentialing specialist will also obtain fee schedules from contracted carriers and provide you with those to be utilized in the billing process. Catalyst offers an ongoing Credentialing, Privileging and Contract Maintenance program, which will be quoted at the end of your initial project.


Credentialing and Privileging Maintenance Program
  • Coordinate and oversee licensure maintenance and expiration dates (medical, DEA, DPS, malpractice insurance) including notification to providers before expiration. (Provider is responsible for actual completion of the required renewal)

  • Maintain providers CAQH account and attest so file will stay current. This also includes submitting updated licensure and malpractice face sheets

  • Maintain provider credentials files according to applicable state applications, to include all personal, licensure, and demographic information

  • Complete reappointment applications and complete paperwork requests for hospital membership and privileges

  • Complete re-credentialing documentation for health plans

  • Act as a liaison between the provider and the hospital and/or health plans


Contract Maintenance Program

Catalyst offers providers an active maintenance program for contracting, credentialing and privileging needs to take the burden off of your office staff. The following areas are included in our Contracts Maintenance Program:

  • Maintain participation status with contracted plans including commercial and government payors

  • Provide ad-hoc managed care contract support for physician contracts with all contracted payors

  • Coordinate updates or changes in reimbursement schedules with your billing company or office management for upload to billing software

  • Provide language and fee schedule review for new contracting opportunities

  • Provide ongoing support and updates to billed charges, as necessary

Credentials Verification Organization (CVO) & Compliance Services

Catalyst Consulting offers unparalleled Credentials Verification Organization (CVO) services to healthcare organizations across the nation. With expertise in The Joint Commission, AAAHC, URAC, NCQA and CMS accreditation standards, Catalyst Consulting is committed to providing quality credentialing to our clients. Catalyst’s team of Certified Provider Credentialing Specialists (CPCS) will ensure that your organization's credentialing files are completed with accuracy and in compliance with regulatory standards, so you can rest easy knowing your organization is in good hands.


With customizable user-friendly reports, and 24/7 access to your data on Catalyst’s proprietary cutting-edge software you’ll be able to know in real-time where your organization’s providers are at in the credentialing process.


In addition to CVO services, Catalyst Consulting also offers assistance with mock audits and preparation for pending audits from different accrediting bodies such as The Joint Commission, AAAHC, NCQA, and more.


Primary Source Verification Services

Catalyst collects all information from Primary Sources and ensures that all provider data is verified and in accordance with the Joint Commission, NCQA, AAAHC, and other regulatory standards. The following items are verified according to an organization's bylaws: 

  • License to Practice

  • Work History

  • DEA

  • Board Certification

  • Medical Education

  • Malpractice Insurance Coverage

  • Application Processing

  • Sanctions against licensure

  • Medicare/Medicare Sanctions

  • NPDB Query

  • Malpractice Claims History

  • Hospital Affiliation Verification/Work Site Verification

Sanctions Monitoring and Reporting

Sanctions are disciplinary actions imposed against licensed providers and can have far-reaching consequences. OIG guidelines clearly state that healthcare organizations cannot employ sanctioned or excluded individuals. If an organization fails to disclose any excluded providers employed, the organization can be fined upwards of $100,000 per excluded employee. Now, more than ever, it is exceedingly important for organizations to take proper action to monitor their providers for sanctions and exclusions.

Catalyst Consulting helps healthcare organizations maintain compliance by identifying through The Office of the Inspector General: U.S. Department of Health and Human Services (OIG), The General Services Administration (GSA), and The Department of the Treasury (OFAC), on a monthly basis, providers who have been sanctioned or excluded from participation in state and federal healthcare programs. Potential matches are investigated by Catalyst and results are returned to your organization immediately for processing.

Expiring Document Management

Expiration dates of time-sensitive credentials are monitored and updated on an on-going basis. Reminders are sent to providers on a client customized timeline. (120, 90, 60, 45, 30, 15 day marks are all options)

  • Primary State license

  • DEA License

  • CSR

  • Malpractice Insurance

  • Board Certification

  • CPR

  • Driver License

  • CSR License

  • Hospital Reappointment Dates- No limit to hospitals tracked.

  • And many more, as required

Credentialing and Contracting Services
Ongoing Maintenance
CVO and Compliance
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