Navigating sticky credentialing for a new Urgent Care facility

ABOUT

The client is an urgent care facility in Michigan.

CHALLENGES

The group was non-par with Blue Cross PPO plan leading to denials, which the facility was not aware about. Further, payments were mailed to an older address that the primary doctor was associated previously.

WHAT WE DID

We coordinated with Blue Cross PPO and determined that under the specific plan the insurance company did not allow for groups to be credentialed. We then worked towards credentialing individual doctors so that payments can be received directly. After credentialing was achieved, the insurances continued to mail payments to the doctor’s older address. We worked with the insurances to update their databases so that payments were correctly mailed to the right location.
Further, we helped successfully setup an interface between the EHR (Practice Fusion) and AdvancedMD (the practice management system) used at the facility.

LIFE WITH NEXTSERVICES

Urgent care is a rapidly growing area of medicine with great competition. Sometimes establishing a new facility requires navigating sticky issues with credentialing as it happened with this client. The experience of our transition team helped quickly zero in on key issues so that there’s minimal disruption with payments. The facility continues to enjoy the benefits of methodical billing practices that our team brings.