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Catalyst Consulting

PROVIDER CREDENTIALING & CONTRACTING

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.

From private practice to corporate health care organizations, Catalyst helps you maximize operational efficiency and optimize employee workflow.

Our Credentialing & Contracting Services Include:
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  • New Provider Enrollment, Credentialing & Contracting

  • Hospital Privileging

  • Medicare and Medicaid Provider Enrollment and Credentialing

  • Medicare Revalidation

  • Medicaid Re-enrollment

  • NPI Registration

  • Ongoing Credentialing, Privileging & Contract Maintenance


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Doctor and Patient

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, compliance, and credentialing. 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 assists providers in determining which insurance carriers and networks to pursue participation status with. Additionally, we maintain your CAQH database as required by the carriers. Our credentialing specialist completes the onboarding process and loads all required documents into our secure database.  Applications are completed for all plans requested and tracking and reporting on the status of your enrollment are performed until you are loaded in the carriers’ databases. We provide ongoing updates to you and your staff throughout this process.  Your credentialing specialist will also obtain fee schedules from contracted carriers and provide you with those to be utilized in the billing process going forward. Catalyst offers an ongoing Credentialing, Privileging and Contract Maintenance program, which you can opt to enroll in at the completion of your initial enrollment.

 

Credentialing and Privileging Maintenance Program:

  • Coordinate and oversee licensure maintenance and expiration dates (medical, DEA, DPS/CDS, malpractice insurance) including notification to providers before expiration (Provider is responsible for actual completion of the required renewal of medical license)

  • Maintain providers CAQH account and attest so files 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 managed care plans

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

  • Attest and maintain health plan provider directories as needed

  • Monitor and complete Medicare/Medicaid revalidations when due

 

Contracts 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

  • Provide language and fee schedule review and interpretation for new contracting opportunities

  • Provide ongoing support as requested

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