Each health plan has its own process for completing a provider’s credentialing and if not handled properly, can lead to lost revenue and a poor patient experience. Additionally, the process of becoming an in-network provider is time-consuming and requires expertise to navigate our convoluted healthcare contracting system.
Correct coding is critical to getting paid properly for services rendered and avoiding external audits by Medicare and other payers. Improper coding can result in lost revenue and fraudulent claims can subject a practice and individual providers to hefty fines and jail time.
- CATALYST services include contract procurement, evaluation, negotiation, compliance, credentialing, and payment auditing.
- CATALYST offers an active maintenance program for contracting, credentialing and privileging needs.
- CATALYST interprets health plan fee schedules to track and monitor allowable charges versus payments.
- CATALYST offers assistance with mock audits and preparation for pending audits from different accrediting bodies such as The Joint Commission, AAAHC, NCQA, and more.
- CATALYST employs a team of experts that have the experience and know-how to increase profitability and identify risks through a documentation and coding audit.
- CATALYST corrects under-coding, code overuse, and bills appropriately for each documented procedure.
- CATALYST performs analysis at the practice level to reveal coding deviations from national averages.
- CATALYST trains staff how to document properly, prevent the use of outdated or incorrect codes, and protect against fraudulent claims being filed.
Our Credentialing and Contracting Services Include:
- New Provider Credentialing, Privileging & Contracting
- Commercial Insurance Plan Provider Enrollment, Credentialing and Contracting
- Medicare and Medicaid Provider Enrollment and Credentialing
- Workers Compensation Provider Enrollment
- Medicare Revalidation
- CAQH Registration and Maintenance
- NPI Registration
- In-Network Provider Validation
- Ongoing Credentialing, Privileging and Expirables Maintenance Programs
- Primary Source Verification
- Provider Expirables and Sanctions Monitoring
- Coding and Billing Chart Audits
- Ad-hoc projects
Continuing Education Solutions
Why risk costly delays or mistakes?
Credentialing and contracting are not a choice. They are required for your practice to bill and collect for your services. Why risk this important process being done incorrectly or without proper follow up?
Catalyst Consulting can help
Provider enrollment, credentialing and contracting are vital to your organization’s financial success. The trusted credentialing specialists at Catalyst Consulting have the experience and know-how to handle this important aspect of your business operations. Let us guide you through the many details and the planning involved in starting a new practice or adding providers to your current contracts.
Over 90% of medical practices do not know what their fee schedules are, much less if they are being paid correctly. We assist existing practices with obtaining, interpreting, and managing fee schedules in order to track and monitor allowables vs. payments on an ongoing basis.
Our seasoned practice managers help you to make informed business decisions that will affect your bottom line for years to come. We take the burden off you and your staff so you can focus on your patients and enhance practice profitability.
Our Areas of Expertise Include
Credentialing & Contracting
Commercial Insurance Plan Provider Enrollment, Credentialing and Contracting
Medicare and Medicaid Provider Enrollment and Credentialing
CAQH Registration and Maintenance
Ongoing Credentialing, Privileging and Expirables
Fee Schedule Maintenance
- Practice Administrator, Austin Primary Care Physicians “I absolutely love Catalyst Consulting. I feel very lucky that I have a very helpful resource should I need help with any of my many duties. I am Practice Administrator of a very busy Primary Care practice that specializes in Internal Medicine. I wear many hats and often find myself needing additional resources. I have worked in a medical clinic for 6 + years and have used Athenahealth for the same amount, yet I still am not confident in two specific areas: Medicare credentialing and physician compensation plans. Catalyst took Medicare credentialing off our hands, as well as switched our contracts from single to multi-specialty when we added a Podiatrist to our group. I would not have had the time to perform my duties on top of this major change to our contracts. Second, I am not too familiar with physician compensation plans since my last employment had a straight salary structure. Tamra Swindoll connected me with Rob Hardy who has expertise in this area! I already feel much better about my duties knowing I have Catalyst team to help me in some of the “hats” I am required to wear. I will continue using Catalysts services for a very long time!”
- Practice Administrator/Marketing Coordinator, Urgent and Family Care at Avery Ranch“Urgent and Family Care of Austin, Texas has been utilizing the services of Catalyst Consulting for credentialing and contracting services since 2006. We have recently utilized their marketing services. Every interaction with an employee of Catalyst Consulting has been a pleasant one. All staff members are very knowledgeable in their particular areas. It is a breath of fresh air to work with a company that is always professional, very knowledgeable and dedicated to providing us with the best possible rates or solution to a problem while providing exemplary customer service. If you are looking for a company to take care of your credentialing and contracting Services, marketing services or any of the many services they offer, look no further. Catalyst Consulting is the answer.”
- Office Manager, Nurture Ob/Gyn “I am very happy to boast about Catalyst Consulting! I worked at Nurture Ob/Gyn from 2011-2015. Catalyst Consulting was a huge help to the start-up of Nurture Ob/Gyn! CEO Tamra Swindoll, Patrick Boyle and Zack Ragsdale made our practice startup very smooth! Dr. Andrea Campaigne had never run a business before so was very lucky when she found Tamra Swindoll to help her with all turn-key practice items. First, Catalyst Consulting connected Dr. Campaigne with a location quickly to rent and practice at immediately. Other items Catalyst helped Nurture with included an amortization schedule, finding an Electronic Medical Record and Practice Management softwares that would help us succeed, sample office forms and policies, staffing needs, equipment needs and ongoing support as anything came up that we weren’t aware about. In addition to this, Catalyst quickly credentialed us with all major insurances! We were up in running within 30 days thanks to Catalyst. I would say the best thing Catalyst did for us was introducing us to Athenahealth! Athena was the best software for our billing needs! Athena had everything we could imagine on the back end such as inputting which insurances that we were credentialed with or which ones were pending. We loved the CPT lookup tool in case we were unsure of a certain code to bill. We loved that flag notes would pop up before a claim was submitted should Athena notice any errors with our coding. The notes would tell us if a CPT code should be bundled, etc. Neatest thing! These are just a couple items that ensured our financial success. All in all, we were very lucky to have the support of Tamra and her team on our side. I would definitely say that Catalyst Consulting contributed largely to the success of our practice!”
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