Need Credentialing Quote

[jmgiusti]

I wanted to clarify, this is not a "start-up" non profit, they have been in business 35 years, it will just be the expanded Line of Business that is considered start-up. Thank you everyone!


Aloha ladies and gentlemen,....  Alice & Michelle
My name is Jessica and this is my first post. I do medical billing for a palliative Line of Business for a hospice as well as some UB04 and Medicare DDE. I also began my own business 1 year ago and currently remote bill for one chiropractor and have several leads and a quote or two out there for primary care providers and PCMH. I also have a "little bit" of credentialing follow up and experience. (couldn't get another chiropractor credentialed with ASH through CAQH, he had MCR and loan issues unbeknownst to me, so I learned alot and made............well you know.

This is what I need:  I responded to a craigslist add of a non-profit who was looking for someone to do their credentialing. I didn't offer to do it and still am not necessarily, but I know this is a good way to lock in a prospect for the medical billing portion that I want.

I need a quote or pricing from Medical Billing Solutions to do his credentialing. What I know and what I need are listed below.
 
What I know: This is a start up non-profit on the West side of the Big Island (Hawaii). They are a state licensed rehab center who has their own NPI. They have, possible 2-OT's, 2-PT's, and 2-ST's, in combination full and or part time and they would like to get them all credentialed for the major insurance companies here in Hawaii. To them that would include HMSA, UHA, OHANA Health Plan, Aloha Care, UHC, Medicaid and eventually Medicare to start with ( I must admit I was looking at the HMSA website and I know the three disciplines mentioned above, in order to participate with their Medicare Advantage plans, require a PTAN, so maybe Medicare is just an obvious addition and needed now). The gentleman I talked to ( while not necessarily now) is a licensed psychotherapist in Texas and  I think an LCSW but not in Hawaii , he would like to be but not main priority but....)

Michelle and Alice, I believe you will be one of the mowst reasonable and efficient services out there, but maybe you too, only offer this in reference to obtaining the billing portion also? ) I tried your phone number but, Hawaii time, I missed you by half an hour and........ This "potential" client has someone other than me stopping by to discuss credentialing with him tomorrow about 11:00 Hawaii time.

Love to hear from you or anyone on a realistic and fair quote for this non-profit start up looking to expand their organization into a "full rehab center".


First post, love you guys, read the forum all the time, bought your entire Medical Billing Business in a Box and have methodically been planning for years. just got my BA in Health Care Administration, CMRS-AMBA, HIT-TR (Office of the national coordinator workforce development program) haws taken me along time to break into the healthcare industry, have been billing for hospice about 5 months now with business start up about a year ago. Slowly...........we go and quickly we learn!

Thanks to all of the knowledgeable experts and everyone else in this forum!
Sincerely,
Jessica M Giusti

[Michele]

I need a quote or pricing from Medical Billing Solutions to do his credentialing. What I know and what I need are listed below.
 
What I know: This is a start up non-profit on the West side of the Big Island (Hawaii). They are a state licensed rehab center who has their own NPI. They have, possible 2-OT's, 2-PT's, and 2-ST's, in combination full and or part time and they would like to get them all credentialed for the major insurance companies here in Hawaii. To them that would include HMSA, UHA, OHANA Health Plan, Aloha Care, UHC, Medicaid and eventually Medicare to start with ( I must admit I was looking at the HMSA website and I know the three disciplines mentioned above, in order to participate with their Medicare Advantage plans, require a PTAN, so maybe Medicare is just an obvious addition and needed now). The gentleman I talked to ( while not necessarily now) is a licensed psychotherapist in Texas and  I think an LCSW but not in Hawaii , he would like to be but not main priority but....)

Love to hear from you or anyone on a realistic and fair quote for this non-profit start up looking to expand their organization into a "full rehab center".

Hi Jessica,

Wow, being in upstate NY I think that Hawaii is the oposite end of the earth (even though I know it's not!).  Anyway, we aren't doing much in credentialing right now, we refer most people out to a lovely gal named Carolyn.  But I do think I can still help.

First, when we did our credentialing we only did credentialing, not contract negotiation.  (Just wanted to mention that.)  We also wanted to make sure we were paid for our work, but reasonable cost for the provider.  Many services (credentialing) charge very high prices.

We charged one fee for the Medicare apps ($275 for a group app, up to 2 providers, the EFT form and the 460, then $75 for each addt provider)  (So a group practice with 6 providers would cost $575)

We charged one fee for CAQH applications (online universal credentialing app used by most major insurance carriers).  ($150 per CAQH)

Then we charge per insurance carrier for all commercial insurances.  We used to charge $75 per carrier which we think is now way too cheap.

I hope that is helpful!

[jmgiusti]

Thanks Michele, I knew you would come through, yes that information helps a great deal. I agree people charge waaayyyy! too much. Got a quote yesterday, it would have been close to $7250 for 6 providers. That is at $1250 each (startup package) for up to 10 plans, don't think it included Medicare but maybe and that is with the "waiving" (throwing the dog a bone) the $250 each for CAQH.

This "lovely  gal" Carolyn, do I need to call you to get her contact information? I am pretty sure I checked the box that said "allow members to send me email" Is that more convenient for you. or can I post it here.

Think I will go pick up your book on credentialing real quick, and then I appreciate the detailed form information as well for the Medicare you post on your site. Yes, I do not want to do contract negotiation, while I do handle, view and understand the negotiations from the Hospice I work with, this is a whole 'nother animal. My inexperience in this area would be a disservice to this organization. At the same time as a non profit they handle a lot of Medicaid and these rates "are what they are", Medicare and MCR Advantage are what they are.

To the experienced contract negotiators with regards to Massage, Speech & Occupational Therapists & commercial Insurance rates, I wouldn't think there is actually much negotiation here, they have their published plan rates and their HMO & PPO (with the ACA there are 10,000,000 more now). But these are what they are for the most part,..........................right...........or...................absolutely no........always can negotiate. THANKS TO ALL THE EXPERTS!

[Michele]

I will send you a personal message with Carolyn's contact info since I don't have her permission to post publicly.

[jmgiusti]

Thanks Michelle, I received this!