Provider credentialing and insurance contracting are related but distinct processes. Credentialing generally involves verifying a provider’s qualifications and eligibility, while contracting establishes the provider’s participation agreement and applicable contractual terms with an insurance payer.

Medvantis assists healthcare practices in coordinating the contracting process and following up with insurance companies to help move payer participation forward.

Our contracting support includes:

• Payer Contracting Coordination: Assistance with initiating and tracking requests to participate in insurance networks.
• Contract Application and Documentation: Preparation and coordination of required contracting forms and supporting documentation.
• Contract Status Follow-Up: Communication with payer representatives to track pending contracting requests and outstanding requirements.
• Contract Review Coordination: Organizing proposed agreements and helping practices identify key terms, including reimbursement schedules, effective dates, and participation requirements, for review.
• Fee Schedule Coordination: Assistance with obtaining and organizing applicable fee schedules and coordinating questions about reimbursement terms with the payer.
• Contract Execution and Effective-Date Tracking: Follow-up on outstanding signatures, executed agreements, and confirmed participation effective dates.
• Ongoing Payer Relationship Support: Assistance with payer record updates, provider additions, practice location changes, and related administrative requests.

Contract approval, network participation, reimbursement terms, and effective dates are determined by the respective insurance payer. Contract negotiations and legal review can be coordinated with the practice’s authorized representatives or legal counsel as needed.