Most practice problems repeat: a provider added before the payer work finished, a contract that stopped working, records that stopped agreeing after a business change, and staff working around a system nobody owns. Here are five of those, and what it took to fix each one.
Practice Growth Consulting
Five payer applications for one October start, an office added to the existing contracts, and a payer that confirmed the new location then never loaded the group contract. Also two problems that looked like billing and weren’t.
Practice Operations And Workflows
Anyone who opens a shared file can change it, and nobody does it on purpose. Ninety-seven approved masters that staff can use but can’t overwrite, with access matched to each role across two SharePoint sites.
Payer And Medical Billing Transition Support
One Tax ID change went to four insurers through five different processes: two portals, two emails, and a fax. One payment enrollment came back denied purely because the insurer hadn’t loaded the new Tax ID yet.
Spravato Operations
Scheduling an esketamine patient means knowing the authorization dates, the room time left, and the follow up status at the same moment, and no single screen showed all three. So we watched the work first, then built the view.
Before any payer work starts, the practice’s own records have to agree with each other. On another provider engagement we checked the W-9, the organization NPI, the state business record, and the DataSpring provider profile (formerly CAQH) against one another, and they didn’t match.
Sorting that out first is cheaper than having four payers reject the same application for four different reasons.
The four payer scope covered Moda, Aetna, PacificSource, and Regence.
Helping Children Achieve Family Therapy Professional CorporationInsurance Credentialing
Pharos Therapy LLCInsurance CredentialingCredentialing packages and Ongoing Billing have published prices. An Automation Program is $1,250 a month for four months, or $5,000 per workflow, and anything bigger gets a written scope first.
Most of our services have published prices. Larger or more complex setups and ongoing partnerships get a written scope and price before they start.
