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Cedar Rapids, Iowa 52401-1916
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Credentialing and Enrollment

As a delegated credentialing entity, Paramount Health Options (PHO), has access to several benefits that individual or group practices cannot obtain on their own. These benefits include faster payments for newly enrolled providers, improved data integrity and confirmation of enrollment from the payer. PHO customers rate the provider onboarding process as one of the most valuable aspects of their membership. 

In 2015, PHO formed Paramount Credentialing Verification Organization, Inc. (PCVO), a wholly-owned subsidiary, to meet specific customer credentialing needs throughout the country. PCVO received national certification by the National Committee for Quality Assurance (NCQA) for ten out of ten verification services.  NCQA’s CVO Certification evaluates a CVO’s management of various aspects of its data collection and verification operation, and the process it uses to continuously improve the services it provides. “Achieving CVO certification from NCQA demonstrates that PCVO has the systems, process and personnel in place to thoroughly and accurately verify providers’ credentials and help health plan clients meet their accreditation goals,” said NCQA President, Margaret E. O’Kane.

Credentialing and Enrollment
PHO has obtained delegated credentialing agreements from every contracted payer. Because of PHO's delegated status, members complete one paperless credentialing application versus one application for each payer. At the conclusion of the credentialing process, the provider is awarded the PHO's effective date for all contracted payers. Delegation saves significant administrative time and cost, allows for provider applications to be expedited through the verification and enrollment process and ultimately ensures timely reimbursement for members.

Recredentialing
PHO providers will complete one recredentialing application for all contracted payers.  PHO has streamlined the recredentialing process by prepopulating each application, which significantly reduces the number of questions and forms each provider is required to complete.

Medicare Enrollment and Revalidation
PHO will accurately complete Medicare enrollment and revalidation applications in all fifty states. This includes Part A (facility) and Part B (provider) forms. PHO staff monitors and manages any feedback from Medicare ensuring timely enrollment for providers.

Iowa Medicaid Enrollment
In 2016, Iowa Medicaid selected three managed care organizations. To see Medicaid patients in Iowa, providers are required to enroll in Iowa Medicaid Enterprise (IME) and each managed care organization. PHO completes IME enrollment forms and has delegated credentialing agreements in place with all three managed care organizations.

Hospital Privileging Forms Completion
PHO has a streamlined hospital privileging form process. With one application (and any hospital-specific addendums), PHO will prepare hospital forms, obtain provider signatures, submit the required documents to each respective hospital, and facilitate any necessary follow-up. Members who use this service save valuable administrative time.

Maintenance of Credentials
As a benefit of membership, PHO provides maintenance of credentials. This is a service which conducts queries of all license and certification expirations and notifies offices of soon-to-expire documents. This process ensures provider credentials are kept current.  These credentials include:

  • Malpractice Insurance Certificate
  • State License
  • Federal DEA Certificate
  • State Controlled Substance Certificate
  • Board Certification / Other Certifications

Ongoing Sanction Monitoring
PHO provides an ongoing sanction monitoring service to immediately alert members of a provider identified on any of the various sanction reports. Members are notified immediately of any possible provider match. These reports include:

  • State License Board Disciplinary Reports, as released
  • Office of the Inspector General (OIG) Sanction Exclusion
  • System for Award Management (SAM)
  • Continuous Query of the National Practitioner Data Bank (NPDB)

Contact PHO’s credentialing team at Credentialing@ParamountHealthOptions.com with questions or for more information.