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Provider Payer Credentialing Verification

Medical Billing Service Company NJ

Being unaware of patients' insurance plans will lead to revenue loss and missed payment opportunities. Healthcare organizations should have effective and clear-cut credentialing strategies in place. Not paying enough attention to the credentialing process significantly drives up the possibilities of non-payment and denied claims.

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Healthcare organizations should have in-depth knowledge of the insurance plans their patients have opted for. Often electronic health record (EHRs) and billing softwares will help physicians to view reports that give a clear idea of the revenue tied to each insurance plan. This will help physicians to decide on which plans to enroll for.

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Federal and state exchange plans change constantly. This causes credentialing challenges and uncertainties. Healthcare organizations should focus on keeping abreast with the changes in their patients' plans. The time and cost of enrolling into new exchange plans should be balanced with the patient volume and revenue generated. If the patient volume or revenue generated is high for a certain plan, medical practices will have to enroll immediately in them.

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