Credentialing and Enrollment
As a delegated credentialing entity, Paramount Health Options (PHO), can offer unique benefits to providers and facilities which they could not obtain on their own. The benefits include faster payments for newly enrolled providers, improved data integrity and written payer enrollment/loading confirmations. PHO providers and facilities rate the payer credentialing onboarding process as one of the most valued features of membership.
In 2015, PHO formed Paramount Credentialing Verification Organization, Inc. (PCVO), a wholly owned subsidiary, to deliver customized provider credentialing. PCVO received national certification by the National Committee for Quality Assurance (NCQA) for all eleven elements. NCQA’s CVO Certification evaluates PCVO’s management of various aspects of data collection and verification, operational compliance to standards and policies, and methods used to continuously improve the process and provider's level of satisfaction.
Credentialing and Enrollment
PHO has delegated credentialing agreements from every contracted payer, allowing providers and facilities to complete one paperless credentialing application for seventeen payers versus one application for each payer. At the conclusion of PCVO's credentialing process, the provider is assigned a single 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 in-network reimbursement for providers and facilities.
Recredentialing
PHO providers will complete one recredentialing application for all contracted commercial and government payers. PHO has streamlined the recredentialing process by pre-populating each application, which significantly reduces the number of questions and forms each provider is required to complete.
Medicare Enrollment and Revalidation
While Medicare is not a PHO contracted payer, PHO can accurately complete Medicare enrollment and revalidation applications in all fifty states, including Part A (facility) and Part B (provider) forms. PHO staff monitors and manages feedback from Medicare, ensuring timely enrollment for providers.
Iowa Medicaid Enrollment
Iowa Medicaid has three managed care organizations, Iowa Total Care, Molina, and Wellpoint. 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 both managed care organizations.
Hospital Privileging Forms Completion
PHO's streamlined hospital privileging form process utilizes one application (and any hospital-specific addendums) to pre-populate various hospital privileging forms. Members who use this service save valuable administrative time.
Maintenance of Credentials
As a benefit of membership, PHO 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. 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)
For more information, contact PHO’s credentialing team at Credentialing@ParamountHealthOptions.com.