The New PCS Website

Professional Credentialing Services (PCS) has launched a new website! 

There are new features, such as our clients testimonial page and new Blog section, where we will educate and answer questions about healthcare credentialing.  

Be sure to start following our blogs on the new PCS website:

http://professionalcredentialingservices.com/blog

RISKS of not using a Credentialing Company

Issues can arise for healthcare provider or facilities that are not properly credentialed with insurance companies.  

These issues can include:

·       Delay in payments.

·       Limited patient access.

·       Delay in credentialing with insurance companies, multiple revisions.

·       Not acquiring desired products.

·       Providing consistent care to patient needs because office staff is pulled away to resubmit applications or make calls to clarify what is needed to get contracted.

·       Unresolved questions with insurance companies – patients concerns not addressed – unhappy patients (out of network).

·       Licenses, certificates, etc. could lapse.  Hospitals may not receive updates and compromise staff status.

·       Without a credentialing report, physician and office staff could be unsure of status of applications with insurance companies.

·       Unsure of actions taken and those needing to be taken.

There are various preventatives and resolutions that can ensure a healthcare providers proper credentialing with insurance companies. Credentialing companies, such as Professional Credentialing Services (PCS), can help by working directly with the insurance companies. PCS provides quality credentialing services to healthcare providers nationwide and maintain their master insurance files for timely reimbursements. Here at PCS, we have created a detailed system of required support documents and continuously in contact with insurance companies to avoid credentialing misunderstanding.  We also interface with billing offices to resolve payment errors.  

To find out more information about PCS can help, please visit www.credentialpros.com

or call us at (661) 298-2541

About the Founder

Sue Brophy-Wagner established Professional Credentialing Services (PCS) in 2001 in response to the growing demand for credentialing specialists within the health care industry. In providing credentialing expertise, PCS facilitates Physicians, Management Services Organizations (MSO), and Medical Services Facilities to focus on the primary objective of patient care.

Sue developed her unique problem solving skills early in her career while working in the IT departments of Columbia Pictures, Imperial Premium Finance, and Advanced Bionics among others. This broad based and diverse professional experience helped build her talent for unrelenting trouble shooting and successful resolution of client issues. In 1999, Sue first tackled the emerging credentialing challenge at Valley Healthcare Partners/Sherman Oaks Medical Group where she developed and honed a system of best practices in this new field.

Under the leadership of its native Californian founder, PCS has cultivated exceptional working relationships with provider relation departments within major insurance companies and has nurtured successful relations with medical staff office personnel and client hospitals. Sue attributes the success of these relationships to her firm’s professional approach, maintenance of open dialogue and to furnishing complete and accurate information for client institutions/organizations.

Over the years, PCS’ services feature the combined values of integrity, respect and confidentiality with knowledge, accuracy, and the necessary expertise to provide quality solutions for clients.

To find out how PCS can help you with your healthcare credentialing needs, please visit www.credentialpros.com

Provider Credentialing Summary

 In 1997, the California Medical Association developed a comprehensive application to relieve medical service providers of the burden of completing the many forms required by third party payors to verify the completeness of a provider’s qualifications. Unfortunately most insurance companies do not accept this form and require one of their own applications for credentialing purposes. As a Professional Credentialing Services (PCS) client, the physician need only complete the California Physician Participating Application (CPPA) along with associated Addendums A and B Form, one time only. The answers to this comprehensive application are entered into PCS’s database and are afterward always available for quick and accurate retrieval in whatever formats the provider requires.

There are five distinct steps to the submission and retrieval process once an account has been established.
1. Complete the California Physician Provider Application (CPPA):
This is the source of the data, which will populate the PCS database and need only be submitted once. Occasionally, the provider will be asked to provide an original signature for this form. This will occur if a hospital or insurance company will accept this form in lieu of their standard form. PCS will request regular updates from the provider to keep this information accurate and current.

2. Submit all necessary attachments:Copies of key documents (state license, board certification, CV) will be kept on file at PCS, and will be returned to the provider with each requested application. This eliminates the need for the provider to keep these documents readily available. Additionally every critical license, board certificate or CME hours will be scanned and formatted to become a part of the annual physician disaster recovery CD.

 3. Verify completeness:
Once the provider signs off on the accuracy of the data in the databases, PCS can complete any insurance or hospital form on the client’s behalf.

4. Insurance company application or hospital reappointment request (s):
All requests for information and/or forms you receive from managed care companies, hospitals, and malpractice companies need to be sent to Professional Credentialing Services so we can assure prompt processing. A correct and accurately completed application along with all applicable documents which are on file will be returned to you for verification and signature.

5. Review, sign and send:
Each application will be returned to you with a cover sheet that outlines what data and signatures are required before submission. You must review the application and sign in the appropriate places and return the documents to PCS for mailing. PCS will then track the application to completion.


 *PCS is always available to work with clients to find ways to use provider data for reporting, analysis, and advertisement, whether for the client or third party use.

Contact Professional Credentialing Services at (661) 298-2541 or visit our website http://www.credentialpros.com/

Credentialing is a Healthcare Provider’s Nightmare!

As a healthcare provider, you suddenly find out that your practice has been dropped from an insurance plan and will now be reimbursed at the out of network fee schedule.  Worst of all, your patients may choose to go to another provider because they don’t want to pay the excessive out of pocket expense.  Now it is a high priority to get back on track with the insurance plan.  Unfortunately your staff is pulled away from their job which is to provide your patients with the best possible care.

Maybe you have been dropped out of an insurance plan because you have not returned the necessary paperwork to provider relations or the demographic department.  Perhaps your front office and/or back office staff becomes overwhelmed by the amount of credentialing paperwork.  Have you informed your insurance companies that you have moved, changed your Tax ID or joined or left a group?  You must update the insurance companies to get paid correctly! 

Now about Medicare.  Can you even say Medicare without screaming?  Just when you think you may be getting a grasp, it changes!  The enrollment process is very complex, especially where Medicare is concerned.  If you forget to cross one 't' or dot an 'i', they will kick the entire packet back to you.  As you may know, Medicare can take up to 30 days to returned application to you. Then the enrollment process starts all over.

The average healthcare provider will need to submit, maintain, and track credentialing and recredentialing applications several times a year.  In the bureaucratic nightmare that is the existing medical credentialing system, every medical practice needs to stay on top their credentialing.

In 2001, Professional Credentialing Services was established in response to the growing demand for credentialing specialist within the healthcare industry.  PCS specializes in the complicated and frustrating task of completing and maintaining healthcare professionals credentialing files allowing you to do what you to do best.  Call PCS or visit our website for additional information. 

(661)298-2541

www.credentialpros.com  

PCS will save you time and money, getting you quality results! 

We Work For You!

Our goal is to provide the highest level of quality credentialing services, allowing you to do what you do best – provide exceptional medical care to your patients. We offer the opportunity to outsource the credentialing process, providing exemplary services and outstanding turn-around time.

With Professional Credentialing Services you will be able to:
* Concentrate time on patient care instead of credentialing headaches.
* Eliminate redundant paperwork and errors.
* Relieve valuable staff of the tedious credentialing process
* Gain access to preferred insurance networks quickly and efficiently with our specialized credentialing services.
 
Find out more about our services and how we can help by visiting our website:www.credentialpros.com