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The Importance of Maintaining Up-to-Date Credentialing and Contracting

By May 31, 2019September 12th, 2023No Comments

doctorContracting and Credentialing starts and maintains the lifecycle of the revenue cycle and is a crucial component of any practice’s business strategy.

Unfortunately, Contracting and Credentialing is perceived as routine, when in fact, poor execution can cause problems from loss of income, to exposing practitioners, health care groups and facilities to malpractice and other legal issues, including fraud, if handled improperly.

In the last decade or so, the credentialing process has become complex – and sometimes downright difficult to manage – primarily due to Medicare and Payer compliance changes, accreditations and licensing requirements, and maintenance and updates of practitioner, healthcare groups, and facilities records to Medicare, Medicaid, and HealthCare Payers.

SYNERGEN’s credentialing and contracting services work as your advocate to provide solutions for the endless sea of issues faced by practitioners and healthcare practices for the various credentialing and contracting requirements, at the same time providing solutions to manage the way they track and maintain this data.

Avoid common mistakes and ensure your practice’s credentialing application and provider enrollment process moves along quickly and efficiently in the following areas:


1. HIPAA and Insurance Provider Compliance

Non-compliance with HIPAA can result in serious penalties, with maximum fines reaching more than $1.5 million per year. Ensuring HIPAA compliance is critical, complicated and evolves often. Staying up-to-date on new rules, regulations and practices is key in running a secure, financially healthy practice equipped to protect valuable patient information. For peace of mind, implement a HIPAA compliant, cloud-based practice management and EHR service to house and protect medical information.

Insurers also have a wide range of compliance requirements to stay on top of and failing to do so can cause your health care organization to miss payments for service, spend considerably more time on troubleshooting and increase administrative costs. Incorporating a process automation tool and coding optimizer is essential in ensuring compliance, avoiding audits and obtaining proper reimbursement.

With the ISO/IEC 27001 certification, SYNERGEN Health upholds strict compliance policies, business continuity planning that eliminates disruptions in service and globally recognized processes and protocols to combat security breaches. This certification is essential in ensuring proper credentialing and contracting procedures with headache-free compliance.


2. Re-credentialing and Revalidations

Re-credentialing and Revalidations are complex and should be automated and seamlessly integrated with payer management processes to stay on track. The right web-based credentialing and contracting software can promptly and accurately complete the applications required for provider enrollment, re-enrollment or for updating critical information.


Complex data tasks and growing compliance concerns can prevent organizations from elevating their services and focusing primarily on their patients. When a practice is inundated with time consuming manual procedures, quality of service suffers. Process automation tools can simplify critical administrative tasks and free up valuable time for more comprehensive patient care. With automated payer management, credentialing and contracting services, health care organizations can stay profitable and competitive while saving time and cutting back on costs. To adapt to ever-changing compliance requirements, credentialing and contracting methods must be streamlined and modernized.