SLJ Credentaling Solutions

Services We Provide

Professional Credentialing Consulting

   SLJ Credentialing Solutions will provide professional consulting as requested

• Develop and or Revise Credentialing Policies and Procedures.

• Provide on site consultations in preparation of MCO, Hospital Audits, and Certification/ Accreditations.

 

Hospital Membership/Health Plan Provider Enrollment

• Prepare initial enrollment for third-party payors of healthcare benefits (“Payors”) and hospitals.

• Transmit completed enrollment to such payors and hospitals and track the application through the approval stage.

 

CAQH & Health Plan Enrollment

• Prepare initial enrollment and create CAQH profile for third-party payors of healthcare benefits and hospitals.

• Transmit completed enrollment to such payors and hospitals and track the application through the approval stage.

 

CAQH  Initial Enrollment & Revalidations

• Create an initial CAQH profile for third-party payors.

 

CAQH Profile Update

• Complete the re-attestation process with CAQH.

• Transmit renewed expirables (State licensure, DEA, Malpractice Insurance, etc.)
   

On-Going Credentialing Maintenance

• Function as the liaison between the client and insurance carriers or hospitals with all matters relating to the credentialing/recredentialing process (e.g. missing/expired credentials, application process, etc.).

• Continuous updates & renewal of expirables ( State License, DEA, Malpractice Insurance, CME, etc.).

• Hospital and MCO Recredentialing.

• Maintenance of CAQH profile on a quarterly basis.

 

Government Enrollments Medicare, Medicaid, NPI

• Prepare and submit State Medicaid forms

• Prepare and submit Medicare forms (paper or electronic)- CMS-855B, CMS-855I or CMS 855R (some additional forms may accompany the enrollment process e.g. CMS-588 or CMS-460)

• Medicaid and Medicare Revalidations (paper or electronic)

• NPI Registration (Type I and Type II)

 

Credentialing Verification Organization Services-CVO

Primary Source Credentialing according to your needs and special assignments (The Joint Commission, CMS, NCQA, URAC, AAAHC, DNV, HFAP)

• State Licensure, CDS, DEA

• Malpractice Insurance history (prior years time frame set by entity)

• All Education and Training (Unless Board Certified by ABMS)

• National Student Clearinghouse

• Primary hospital privileges

• Peer references

• Board Certification via AMA and AOA (if applicable)

• Correspond with provider to obtain any missing information if not provided with application

• Query National Practitioner Data Bank

• OIG (Office of The Inspector General)

• FACIS (Fraud and Abuse Control Information System)

• SAM (System for Award Management)

 

Demographic Changes/Updates – Submit changes to the MCO’s, Medicare and

Medicaid regarding changes to provider roster(s), i.e., name change, removal of

provider, adding new practice location(s), change of address, etc.

 

State Licensure & FCVS Services - Our full service includes completion of all

research, license applications and verification forms, routing, tracking, expediting,

follow-up and follow-through on all applications, verifications, queries, reports and

reviews until the Provider’s license and/or FCVS profile is issued.

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