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!