CASE STUDY

Multi-specialty medical organization with 2 main service offerings and 12 locations

WHO THEY ARE

Healthcare organization made up of two of lines of business. The first division has about 70 employees and provides Ambulatory Infusion Services, Home Infusion, as well as two Pharmacies. They have 8 locations and provide services in Tennessee and Arkansas. The second provides Otolaryngology and Allergy & Immunology outpatient services and is located in New Mexico. They have has 1 primary location, with 3 satellite locations. 

THEIR CHALLENGE

Due to enrollment issues, our client had over $500K in rejected claims over eight months. In addition, their credentialing specialist, who had very little experience, had recently left them with no notice. All credentialing was being handled through a manual paper process, and being tracked by spreadsheets, with no real consistent way of keeping track of all the provider's documents. Because of this, they could not confirm compliance per their policies and procedures.

OUR SOLUTION

After a full review, audit, and assessment with the organization’s presidents, we developed solutions to help troubleshoot where the issues were coming from on their Medicare denials. We also identified that a third-party billing company being used was not familiar with how the corporation was enrolled or structured in order to be able to submit claims properly. We developed a collaborative working relationship with their billing company and helped to successfully get all backlog of claims re-submitted to medicare. 

 

We continued to develop processing to help improve onboarding of providers, developed one centralized location for all credentialing documents and items to allow for timely communication. By utilizing CredentialGenie credentialing software, we were able to ensure all documents are tracked as required, and on-going monitoring was established to help keep their files in compliance and up to date.

THE RESULTS

Recovered 80% of outstanding claims with Medicare

Because we are experts in credentialing, we were able to work closely with their leaders to identify the issues causing denials and recoup over $400k for our partner. 

Improved the provider onboarding process

With a formal credentialing process in place and credentialing software implemented, we were able to focus on improving the onboarding experience for providers.

Developed a formal credentialing processes

Before CredentialGenie, our partner had a credentialing specialist with little industry knowledge and therefore, no real process was ever put in place. We changed that. 

Implemented credentialing software

By utilizing CredentialGenie's credentialing software, our client finally had a central location for all their credentialing documents.

Credential Genie was the BEST thing that happened to me when our Credentialing Specialist quit last year.  Her quitting was a blessing in disguise!   I didn’t know that companies like Credential Genie existed and am I so thankful that they do!  Credential Genie came on board and took over ALL of our credentialing needs for both sides of our business. We now have a professional company that takes care of ALL of our credentialing needs and I can do my job and know that things are getting completed on the credentialing side. 

- Project Manager

To learn how CredentialGenie can make a similar impact in your organization, schedule a time to chat below. We can't wait to work together!