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About Our Company

Provider Enrollment Specialists, LLC is focused on provider enrollment or insurance credentialing and everything else that goes along with it.

Provider Enrollment Specialists are experts with plans out of Northern Michigan but we have worked with plans all over the United States. We consist of a team of two professionals with combined 20 years experience in insurance enrollment, insurance contracting, provider credentialing, and Medicare enrollment. PES has the talent and tools to move you through the process of insurance enrollment without the headaches typically associated with this process.

The credentialing process is a tedious process, regardless of who’s doing it, which is why it is so important to have experienced partners at your side. Please select the following areas you are requesting our assistance: Let us handle the headache of paperwork!

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Services

Enrollment

  • Medicare or Medicaid Enrollment
  • Physician Enrollment
  • CAQH Enrollment
  • PECOS Enrollment
  • Government health plan enrollment
  • Obtain NPI and maintenance

Credentialing

  • Behavioral Health, Dental, Medical and Pharmacy Insurance Credentialing
  • Nurse Practitioner Credentialing
  • Physician Credentialing
  • Facility Credentialing

Consulting

Do you really want to keep your credentialing in house but aren’t sure how to handle it internally? Let us show you.  Our dedicated professionals can train in house for 1 week on all insurance credentialing processes and then we are available 90 days remotely for any and all questions along the way.  We have traveled all over the US, helping companies just like yours keep their information in house.  Consult with us to show you the process to getting on insurance panels.  Consulting packages range from $5,000-$10,000 and is only a one time fee!  See what our happy clients are saying about this amazing alternative to outsourcing.

Investment

Credentialing packages start at $75. We try to build a contract around your specific needs and budget.

We believe your focus should be your patients, not on credentialing paperwork. Our contracting and credentialing services are affordable, reliable and save both time and money. Why take a chance on such an important part of your practice, our experts are ready to assist you today! Click here to view what it will cost you for peace of mind.

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Why outsource to us?

As we all know, healthcare facilities exist to facilitate and administer medical care to their patients. While we have advanced like never before in our cure rates, infection prevention, disease management, OR efficiency and nearly every other available metric, the roadblocks to actually running a successful practice have done nothing but increase in size.

Every practice, regardless of its size, is faced with a daily barrage of challenges that aim to prevent or limit the practice’s payment for services. Within the revenue cycle, physician credentialing and insurance enrollment represent the first obstacle in obtaining timely payments and is what we’d like to cover in this article. As you likely know, insurance credentialing or provider enrollment has evolved over the years to be one of the most complicated and confusing processes within any industry. In this article, we’ll review three reasons why outsourcing your credentialing and enrollment department could make your revenue cycle more efficient and your practice more profitable.

Reduced Labor Costs

This is pretty self explanatory and we challenge you to take a close look at what the credentialing and enrollment process is actually costing your organization. In all likelihood, the person tasked with handling your insurance enrollment and credentialing also has a number of other responsibilities within the organization. Unfortunately, these other responsibilities (while they may be important) typically supplant enrollment and credentialing needs as the top priority. With declining reimbursements and rising costs, most practices are forcing more and more on their limited number of employees. While we agree with watching labor costs and distributing work across the practice, it’s critical that certain compliance and credentialing requirements remain at the top of your staff’s to-do list. If you look closely, you will very likely find that your current staff’s workload is unsustainable and is resulting in unnecessary overtime and errors. By outsourcing to a professional organization, you not only reduce the stress level on your current staff but also ensure the top priorities of your organization do not get shuffled to the bottom of the stack. One error or misstep within the credentialing process could literally bankrupt your practice. We have seen it happen numerous times over the years. Whether it’s a Medicare revalidation ignored resulting in the deactivation of PTANs or re credentialing requests that are tossed and result in termed contracts, you don’t need this added liability.

 

Increased Efficiency

Efficiency is key within every industry and healthcare is no exception. If you’ve been running a practice for any length of time, you know that the credentialing and enrollment process often feels like you’re walking in a maze with a blindfold on. Credentialing professionals get out of this maze by relying on advanced technology and payer relationships. An example of this would be a professional credentialing organization’s ability to bypass the 800 number of a provider enrollment department and go directly to a regional network manager. The relationship that bypasses the customer service department usually results in at least 30 days shaved off of the entire credentialing process. In addition to the relationships, advanced technology utilized by professional credentialing agencies ensures the accurate and timely submission of all applications and forms. It also ensures that the correct forms are used and delivered to the correct address, fax number or email.

Eliminate Risk of Turnover

Turnover happens, regardless of how amazing your organization is. When it occurs, it usually happens at the worst possible time, not when you can afford to lose someone. How will your organization be affected by turnover in your RCM or credentialing department? Our company is no exception and has had to deal with turnover in the past ten years. The difference is in our ability to effectively deal with turnover through our commitment to cross training and disciplined project accountability/tracking. These commitments ensure that management is never left in the dark regarding the status of an account and anyone, at any moment can pick up where someone else left off.

In summary, outsourcing credentialing and provider enrollment is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something really worth it? That’s really what you must ask yourself. Rather than watching credentialing needs be displaced to the bottom of the stack, or being done incorrectly by someone who lacks proper training or experience, why not outsource to a professional organization? Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days. We can say that there are only a handful of payers across the country that ever take us more than 4 months to complete. Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

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Why does PES stand out from the rest?

  • Save you on average at least 2 months of time and over 100 or more hours of work!
  • Take away all the headaches due to the mounds of paperwork and endless applications!
  • Increased patient referrals!
  • Get you paid by the insurance companies faster!
  • Contracts and applications are setup right the first time and we will not stop until the process is 100% completed!
  • Dedicated project manager assigned to your project!
  • We make all the phone calls, follow-ups, and submit all applications, e-mails and faxes for you!
  • The service is typically provided at a cost less than it would be for you to hire your own provider enrollment or credentialing team and we can handle any volume you have!