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CredentialingOne – New Credentialing Outsourcing Company Powered by HealthWare Systems

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Press Release

CredentialingOne – New Credentialing Outsourcing Company Powered by HealthWare Systems


Elgin, IL:  HealthWare Systems has launched a new credentialing outsourcing company, CredentialingOne. The new organization is powered by HealthWare Systems’ robotic process automation technology.

CredentialingOne manages all tasks required for provider credentialing and enrollment, Medicare and Medicaid enrollment, obtaining hospital privileges, primary source verification, CAQH registration, and more. The company also provides credentialing-related special projects or overflow services.

The logo of credentialing outsourcing company CredentialingOne.

CredentialingOne – Credentialing Outsourcing Company Powered by HealthWare Systems

HealthWare’s technology enables the dedicated and experienced staff at CredentialingOne to streamline both the initial credentialing process and ongoing credentialing maintenance for individual providers and healthcare organizations of all sizes.

CredentialingOne’s technology solutions include deficiency management tracking that monitors providers’ and hospitals’ expirables (e.g. CE credits, certificates, licenses, malpractice insurance), forms automation software for completing applications quickly and accurately, and an automated alert system to help ensure providers meet deadlines.

“Proper credentialing is critical to a healthy revenue cycle. As a provider of revenue cycle management solutions, it made sense for us to expand the use of our technology into the credentialing services sector,” stated Steve Gruner, CEO and Founder of HealthWare Systems.

“Our ActiveWARE products have a long history of improving revenue integrity and increasing physician satisfaction. CredentialingOne has created a great opportunity for us to help physicians and other providers in a whole new way.”

Mark Hobgood (CredentialingOne’s Director of Credentialing Services) said he looks forward to utilizing HealthWare’s innovative technology in conjunction with his expert staff of credentialing professionals:

“Our Credentialing Specialists have nationwide experience with credentialing, enrollments, privileging, and PSV for all types of providers and practices. Coupling their industry knowledge with HealthWare Systems’ automation technology has produced an ideal solution for those who no longer wish to manage the complexities of credentialing and compliance themselves.”

To learn more about the credentialing outsourcing company, visit where you will find further details about CredentialingOne’s services as well as educational resources to help navigate the credentialing and enrollment process.

About HealthWare Systems:

HealthWare Systems is a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software. We specialize in applying robotic process automation (RPA) to healthcare processes to improve both the patient experience and the revenue cycle. Our ActiveWARE suite of products manages pre-arrival, financial assistance, early out, collections, denial management, claims follow-up, and more, and is proven to maximize productivity and profitability so that healthcare teams have more time and resources to spend on quality care.

About CredentialingOne:

CredentialingOne relieves the stress of credentialing and compliance. Our experienced staff and technology manage this complex and time-consuming process for you, so you can focus on patient care. We offer exclusive technology solutions for quicker application turnaround times. Our forms automation saves time, prevents errors, and ensures consistent documentation. Our alert system notifies practices of upcoming expiration dates at 90, 60, and 30 days prior to expirations. GET CREDENTIALED FASTER… With our secure, cloud-based technology platform you can start practicing and billing payers as soon as possible.

Contact Information:

Name: Stephanie Salmich
Organization: HealthWare Systems
Address: 2205 Point Boulevard, Suite 160, Elgin, IL 60123
Phone: (847) 649-5100

The No Surprises Act requirements affect compliance with provider directories.

How Do the No Surprises Act Requirements Affect Compliance with Provider Directories?

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CredentialingOne Blog

How Do the No Surprises Act Requirements Affect Compliance with Provider Directories?

Posted on Saturday, November 13, 2021

The No Surprises Act requirements go into effect in 2022.

Section 116 of the No Surprises Act, “Protecting patients and improving the accuracy of provider directory information,” seeks to safeguard patients from relying on incorrect provider data that can lead to surprise medical bills.

The No Surprises Act will directly affect all payers and providers who will need to assess their compliance procedures related to provider directories and information verification.

Here is what you need to know about how the No Surprises Act requirements affect compliance with provider directories:
  • Every 90 days, payers must verify providers’ information and providers must assist with this process by submitting regular updates.
  • When providers make changes to their information, online provider directories must be updated within 48 hours.
  • Providers whose information is unverified will be removed from online provider directories.

Essentially, providers will need to maintain their information with payers on about a quarterly basis beginning in 2022 or risk removal from online provider directories and lose the marketing presence that these directories provide when patients search for in-network providers online.

The No Surprises Act requirements affect compliance with provider directories.

Contact us to start preparing for the No Surprises Act requirements.

The No Surprises Act requirements will help keep provider information current and improve the accuracy of provider directories. However, if you’re doing credentialing work yourself, these changes will require you and your staff to commit even more time and attention to credentialing and compliance.

CredentialingOne can handle these time-consuming tasks for you. We offer credentialing and compliance services, including:

We can even build a custom maintenance and monitoring program that works best for your providers and practice.

Providers and payers need to prepare now for the new rules that begin in 2022.

Contact us today to put a plan in place that will ensure you and your providers comply with the No Surprises Act requirements, avoid removal from provider directories, and set the foundation for a successful new year!

By Stephanie Salmich

A provider looks stressed out while she stares at paperwork and is on the phone; the blog title appears: What Happens When Provider Credentials Expire?

What Happens When Provider Credentials Expire?

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CredentialingOne Blog

What Happens When Provider Credentials Expire?

Posted on Monday, April 5, 2021

When provider credentials expire, there can be serious legal and financial consequences for clinicians and their practices. Below we outline the effects of expired provider credentials and explain how you can avoid these negative outcomes.

Expired Provider Credentials Can Result In:

A provider looks stressed out while she stares at paperwork and is on the phone; the blog title appears: What Happens When Provider Credentials Expire?

Don’t let provider credentials expire – Contact CredentialingOne to create your custom credentialing maintenance and monitoring program.

Claim Denials/Lost RevenueWhen provider credentials expire or are not updated, providers are deactivated by payers, their claims are denied, and the practice misses out on reimbursement for services rendered. This could end up costing the practice months of lost revenue since the re-credentialing process can take up to 180 days (or longer due to delays related to the pandemic).

Loss of Privileges If providers’ credentials are not current, they will lose their hospital privileges. This also affects provider enrollment as providers must have hospital privileges at a participating network hospital in order to join and remain compliant with health plans.

Lawsuits/Liability ConcernsA provider may not even be aware at first that a credential has accidentally expired or might realize they have missed a deadline after it’s too late. However, practicing medicine without a valid license (including an expired one) or providing services that require certification which the provider has not renewed can open the door to lawsuits and legal ramifications for not only the provider, but the provider’s employer/facility as well.

Fines and/or SanctionsIf a provider continues to practice medicine as usual even though they have allowed credentials to expire (e.g., writing prescriptions with an expired DEA license), they and their facility may also face significant fines and/or sanctions. Likewise, failure to keep up with state continuing education requirements affects a provider’s medical license status and can cause the provider to be sanctioned by the state medical board. Additionally, the provider’s malpractice insurance rates may increase after receiving a sanction.

Higher Insurance PremiumsAllowing malpractice coverage to lapse may also cause the provider’s premiums to rise, and some insurance companies may decline the provider another policy if there is a previous gap in coverage. The provider will be required to report any lapse in coverage throughout their career.

Refusal of Future Contracts by PayersProviders who have a history of lawsuits, legal penalties, fines, sanctions, lapsed malpractice insurance, and/or expired CAQH attestation may be rejected by some payers for future contracts.

Patient Retention Issues Patients are extremely unlikely to choose an out-of-network provider. Providers who do not remain active with payers will fail to attract new patients and risk losing their existing clientele if they become out-of-network and/or must stop providing care until they are re-credentialed.

Extra Time and Work for Providers/Staff It is much more inconvenient for everyone when provider credentials expire than if the provider had maintained their credentials by the appropriate deadlines. Extra effort and time will be necessary to reactivate the provider with health plans and obtain hospital privileges again.

How to Prevent Expired Provider Credentials & Their Consequences

Keeping track of provider credentials is time-consuming and complicated. It’s easy to miss critical deadlines and expiration dates when providers and practices try to manage this work themselves (for example, with filing cabinets, manual spreadsheets, and handwritten calendar memos that leave far too much room for human error and delays in information delivery).

CredentialingOne can build a custom credentialing maintenance and monitoring program that works with your credentialing policies. We offer a robust software solution for credentialing management and a team of experienced credentialing professionals to handle the work for you.

Our credentialing maintenance and monitoring services include:

  • Our real-time messaging alert system, which sends email and text reminders to the provider when documents are nearing expiration (starting at 120 days prior to expiring).
  • A master report for the practice indicating providers with expiring documents at 120, 90, 60, and 30 days out.
  • CAQH quarterly attestations (we re-attest the provider every 120 days and upload new documents as they are set to expire).
  • Re-credentialing for commercial payers and re-validation for government payers (e.g., Medicare, Medicaid, TriCare).
  • Demographic updates, such as address/phone/name change.
  • Directory updates; Medicare payers in particular request providers to verify their demographic information every 6 to 12 months.
  • NPDB (National Practitioner Data Bank) queries
  • SAM and OIG queries
  • Primary source verification
  • Tracking of malpractice insurance coverage, CE credits, and practice services (e.g., Radiology and CLIA certifications)

We also offer a health plan audit service for larger facilities to ensure providers are participating in the correct plans and the provider roster is current. An annual health plan audit is essential for protecting a practice both legally and financially.

Prevent Expired Provider Credentials with CredentialingOne

CredentialingOne’s expert staff and technology are dedicated to keeping providers compliant and making sure they do not miss credentialing deadlines that are vital to the health of their practice and careers. Contact us to learn more about our credentialing maintenance and monitoring services, health plan audits, and how we can help you avoid the dire consequences that can occur when provider credentials expire.

By Stephanie Salmich

Blocks with healthcare icons are stacked in a pyramid and the blog title appears: New Year’s Resolutions for Providers & Practices

New Year’s Resolutions for Providers and Practices

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CredentialingOne Blog

New Year’s Resolutions for Providers and Practices

Posted on Friday, December 11, 2020

The year is coming to an end and it’s time to plan for a successful year ahead! Have you set any New Year’s resolutions for your practice?

These New Year’s resolutions for providers and practices can help you accomplish your goals in 2021 and beyond:

Blocks with healthcare icons are stacked in a pyramid and the blog title appears: New Year’s Resolutions for Providers & Practices

Set yourself up for credentialing, provider enrollment, and revenue cycle success with these New Year’s resolutions for providers and practices.

Conduct a Health Plan Audit

An annual health plan audit is critical to the success of your practice as it protects it from liability issues, boosts front desk collections, and helps keep providers from being deactivated by payers and having claims denied.

CredentialingOne offers a health plan audit service that determines whether your practice and providers are compliant with all your payers’ contracts and the insurance plans in which you’ve enrolled. For example:

  • Have you notified payers of a provider’s termination, resignation, or retirement within the timeframe required by the contract?
  • Have your providers opted in to any new plans added by a payer?
  • Have your providers opted out of any new plans added by a payer in which they do not wish to participate?

Start the year off right with a health plan audit to ensure your provider roster is current and all providers are participating in the correct plans.

Reduce Reimbursement Denials

In addition to an annual health plan audit, it’s essential to monitor your providers’ credentials throughout the year. Credentialing errors, such as expired certificates or missing CE credits, lead to reimbursement delays, denials, and underpayments.

Any time a provider or practice fails to accurately complete/update their credentialing, provider enrollment, or hospital privileging applications and documentation in a timely manner, they risk a significant loss in revenue. Unfortunately, this is all too common as the credentialing process is complex and it is very easy for items to fall through the cracks or to overlook important tasks like following up on applications.

Allowing a team of experts to handle all provider credentialing and provider enrollment work for you can help prevent claim denials and save you a lot of time and money down the road. CredentialingOne completes this work quickly and correctly, so that providers are credentialed and recredentialed with payers as soon as possible to avoid any breaks to the revenue stream.

Furthermore, we keep track of providers’ and practices’ expirables and our real-time, automated messaging alert system notifies you of any upcoming expiration dates so that you don’t miss a credentialing deadline that would result in denied claims.

A clock and stethoscope are shown and the following statistic appears: 8-10 hours per application is the average time it takes to credential one provider with one payer.

Outsource credentialing to improve work/life balance and prevent clinician burnout.

Improve Work/Life Balance

Clinician burnout is a major concern for providers and practices alike and is often the result of too much paperwork, administrative burdens, and working long hours.

Providers spend an alarming amount of time on EHR and desk work. On top of this, credentialing and provider enrollment are complicated, ongoing, and time-consuming processes that usually take longer and are more involved than the clinician expects. Completing just one application to credential a single provider with one payer takes about 8-10 hours; and most providers enroll in at least a dozen different health plans (each with its own unique application process).

Make preventing clinician burnout a top goal for your practice this year – outsource credentialing and give your providers more time to care for patients and their own well-being!

Keep Your New Year’s Resolutions with CredentialingOne

CredentialingOne can help you reach these goals and more. Contact us to learn more about our services, and start the credentialing process with us before the new year!

By Stephanie Salmich

A person holds a note reading “TODAY IS THE DAY” and the blog title appears: 4 Reasons to Start the Credentialing Process TODAY

4 Reasons to Start the Credentialing Process TODAY

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CredentialingOne Blog

4 Reasons to Start the Credentialing Process TODAY

Posted on Wednesday, November 11, 2020

It can be tempting to put off a complicated and time-consuming process like credentialing, but that is the last thing you should do!

Here are 4 reasons to start the credentialing process TODAY:

#1. The credentialing process usually takes longer than expected.

Credentialing can take up to 180 days, but generally the process takes 90-120 days, and contracting with payers can take 60-90 days (and any of these timelines may be extended due to delays caused by the current pandemic). It’s best to be as prepared as possible on your end so that you can make up for and anticipate delays from insurance companies or other entities involved.

For example, primary source verification must be completed by validating credentials for each provider through direct contact with the person or organization that originally issued each credential.

Since the credentialing process requires reaching out to numerous different contacts and following up with those who fail to respond quickly, it’s important to allot plenty of time to the work. The usual time a person will dedicate to each application is 7 to 9 hours from submission to effective date.

#2. Begin practicing and billing payers ASAP.

A person holds a note reading “TODAY IS THE DAY” and the blog title appears: 4 Reasons to Start the Credentialing Process TODAY

TODAY is the day! Contact us to start the credentialing process.

Any delays in the credentialing process can lead to postponements in employment start dates and/or reimbursement setbacks. Patients also are highly unlikely to seek care from an out-of-network provider.

Accurate and timely credentialing and contracting with payers will help you both prevent claim denials and attract more patients.

#3. Reduce holiday stress.

Don’t use the holidays as an excuse to stall the credentialing process. Start now, BEFORE the holidays, so you can enjoy them without any looming credentialing tasks hanging over your head.

This past year has been challenging for everyone, especially those in the healthcare field. Why not outsource credentialing to help with relieving provider stress and preventing clinician burnout?

#4. Set yourself up for success in the new year.

Getting started now can make a huge difference to the success of your practice in 2021. The longer you wait on credentialing and payer enrollment tasks, the more you’ll cut into next year’s revenue and reimbursement. Plus, you may be setting yourself up for a lot of extra work that will be needed to resubmit any denied claims that could result from credentialing and payer enrollment holdups.

Use what’s left of 2020 to start the credentialing process so that you can spend the new year helping patients and growing your practice, rather than dealing with credentialing and reimbursement issues.

See our previous blog for more tips for provider credentialing.

Start the Credentialing Process with CredentialingOne

Starting the credentialing process can feel overwhelming, but it doesn’t have to be! CredentialingOne removes the hassle by managing all provider credentialing and provider enrollment work for you. This includes completing, submitting, and monitoring all applications related to credentialing and provider enrollment in commercial insurance plans and Medicare and Medicaid, obtaining hospital privileges, and CAQH registration.

Contact us TODAY to start the credentialing process right away!

By Stephanie Salmich

An accuracy meter hits Level 100… prevent claim denials with accurate and timely credentialing.

Prevent Claim Denials with Accurate and Timely Credentialing

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CredentialingOne Blog

Prevent Claim Denials with Accurate and Timely Credentialing

Posted on Thursday, March 5, 2020

In order to prevent claim denials, accurate and timely credentialing is essential to your practice. Credentialing has a major impact on the revenue cycle as the slightest error or interruption in the process can result in claim denials, underpayments, and reimbursement delays.

And payments for services delivered are not the only thing at stake – you also risk losing the business of patients who don’t want to go out of network while you wait to be accepted by their insurance plans.

You can prevent claim denials and other damages to your revenue cycle through accurate and timely credentialing. By both avoiding credentialing mistakes and completing the credentialing and recredentialing processes as quickly as possible, you can protect your practice’s cash flow and revenue integrity.

Below we outline just a few of the credentialing mistakes that can affect reimbursement by holding up credentialing applications and/or causing claim denials.

Avoid these mistakes that cause application processing delays or rejections:

  • Not allotting enough time for the credentialing process
  • Errors in credentialing application paperwork and contact information
  • Omitting required information or documentation from applications
  • Leaving form fields blank or not fully completing each form
  • Unexplained gaps in work history
  • Unresponsive or lagging peer references
  • Malpractice insurance for the practice a provider is leaving, rather than the one they are joining
  • Outdated or incomplete CAQH application
  • Lack of follow-up on application status

Avoid these credentialing-related billing and compliance mistakes:

  • Submitting a claim using physician or practice data that does not match what the payer has on file
  • Submitting a claim for an office location that is not in the payer’s system
  • Failing to confirm payers have the correct provider billing address
  • Forgetting to notify a payer when a provider terminates (e.g. resigns, retires), when the plan requires the practice to do so within 30 days of the termination
  • Not realizing that credentialed providers may need to opt-in to new plans that a payer has added
  • Not realizing that credentialed providers may need to opt-out of new plans that a payer has added, or they may automatically be included in them
  • Missing deadlines for CE requirements
  • Missing renewal deadlines for expiring certificates, licenses, insurance, etc.

These solutions can help ensure you avoid credentialing mistakes that impact the revenue cycle:

Prevent Claim Denials with an Annual Health Plan Audit

An accuracy meter hits Level 100… prevent claim denials with accurate and timely credentialing.

CredentialingOne’s accurate and timely credentialing services can prevent claim denials and protect your revenue.

Conduct an annual health plan audit to verify your providers are participating in the correct plans, payers have been updated on your current roster of providers, and front desk staff understand the plans with which you hold contracts.

You should audit regularly to keep up with provider and front desk turnover and periodic changes to health plans. CredentialingOne provides a health plan audit service, which typically takes fewer than 30 days to complete.

Prevent Claim Denials Related to Ongoing Credentialing Maintenance

Additionally, you should continuously monitor your providers’ compliance with health plans. Even after providers are enrolled with payers, there are plenty of opportunities for reimbursement issues resulting from compliance violations and/or recredentialing/revalidation errors.

CredentialingOne tracks our clients’ expirables (e.g. certificates, licenses, malpractice insurance, CE credits) and our automated, real-time messaging alert system notifies practices and providers of upcoming deadlines 120, 90, 60, and 30 days prior to expirations.

Through deficiency management we can help you prevent claim denials related to avoidable compliance breaches.

Prevent Claim Denials by Outsourcing Credentialing

Outsource credentialing with CredentialingOne and we will prevent claim denials related to credentialing issues for you. Our Credentialing Specialists are experts in correctly and quickly completing all tasks related to credentialing and compliance for our clients.

We make sure you avoid the credentialing mistakes listed above and our credentialing technology solutions streamline the process to get you credentialed and recredentialed with your payers faster.

Contact us today to learn more about how our accurate and timely credentialing services can prevent claim denials and protect your revenue.

By Stephanie Salmich

Outsource credentialing with CredentialingOne in 2020.

Why Outsource Credentialing in 2020?

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CredentialingOne Blog

Why Outsource Credentialing in 2020?

Posted on Monday, January 6, 2020

There are many reasons to outsource credentialing this year. Below are just a few of the benefits of choosing a credentialing services provider to manage the process for you.

Outsource Credentialing to Ensure Credentialing Compliance

Credentialing can become “out of sight, out of mind” following completion of the initial credentialing process.

However, the credentialing life cycle of a practice includes maintenance of provider credentials. Monitoring CE credits, expiring certifications, licenses, and insurance is a detailed task and without a dedicated credentialing team of experts, opportunities for human error are significant.

Re-credentialing or re-validation with commercial and government payors is also a part of the credentialing life cycle. Payors will re-credential or re-validate a provider every 2 to 3 years. Failure to complete re-credentialing or re-validation will result in claim denials and lost revenue.

Outsource Credentialing to Prevent Claim Denials

Credentialing directly affects the cash flow of a practice. Yet, many practices do not think about credentialing until something triggers there is a credentialing-related issue.

A BIG trigger occurs when a claim is denied or reimbursement is lower than anticipated. If the issue is not due to how the claim was filed, then the reason may be related to provider credentialing.

For example, a provider may not have completed re-credentialing or may not be participating in the plan in which the patient is enrolled. Non-credentialed or non-paneled providers do not receive any reimbursement for their services from plans with no out-of-network benefits (e.g. HMO plans).

Lower-than-expected claim reimbursement can also be attributed to the out-of-network benefits the patient’s plan offers. PPO plans, for instance, have out-of-network benefits with higher deductibles, co-pays, and lower co-insurance levels.

Every practice needs an experienced team solely committed to credentialing maintenance so that nothing slips through the cracks. Outsourcing with the CredentialingOne team yields the additional advantage of innovative technology that monitors credentialing compliance and automatically alerts you to pending expirations.

Outsource Credentialing to Save Time & Resources

A provider may see 25 to 35 patients (or more, depending on the practice) on an average day. Providing medical treatment is a full-time job; but making sure the practice is profitable is also both essential and time-consuming. This is the main reason practices outsource services to experts in various industries.

CredentialingOne’s expert staff and technology complete all credentialing documentation, track applications through fulfillment, and follow up when necessary. With CredentialingOne you can maximize cash flow by preventing claim denials and other credentialing issues and do so without sacrificing time and attention away from patient care.

Outsource credentialing with CredentialingOne in 2020.

CredentialingOne: Your external credentialing solution. Outsource credentialing with us in 2020.

Providers are in the business of healing – providing comfort and compassion to patients and their family and friends. Most chose this profession for their passion for helping others, not for the extensive administrative work and time that the credentialing process requires.

Connect with CredentialingOne in 2020 – outsource credentialing this year and let us take the burden off your hands!

By CredentialingOne

An annual health plan audit is performed.

Why an Annual Health Plan Audit is Critical to Your Success

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CredentialingOne Blog

Why an Annual Health Plan Audit is Critical to Your Success

Posted on Tuesday, December 3, 2019

Conducting an annual health plan audit is critical to the success of your practice. Over the life of a practice, providers and staff come and go and insurance companies add and terminate health plans. Keeping track of these changes is key to protecting your practice from legal issues and ensuring adequate cash flow.

Protecting Your Practice

When a new provider joins a practice, they must of course become credentialed and linked to the practice’s payor contracts in order to be considered “in-network.” However, most practices forget that they must notify their payors when a provider leaves their practice as well.

Payor contracts include language requiring a practice to send notification within a specific time frame when a provider terminates. Not only does notification of the termination date keep the practice compliant with these contracts, but it also protects the practice if the provider experiences malpractice issues or sanctions after leaving the practice.

Performing a health plan audit can ensure all payors are up to date on the providers currently associated with your practice.

Improving Front Desk Collections

A health plan audit is also crucial for front desk collections.

Turnover of front desk staff is not uncommon for any practice. It is vital that both your new and experienced staff members know the plans in which each provider participates. They also must be knowledgeable about the payors with whom your practice holds contracts.

Without a current roster of plan participation, the front desk will not know the appropriate co-pay or deductible to collect and your cash flow will bear the consequences.

An annual health plan audit is performed.

An annual health plan audit helps your practice maintain compliance and improves cash flow.

CredentialingOne’s maintenance and compliance services include an annual health plan audit. We can also provide health plan audit services on a standalone basis for clients.

The health plan audit process usually takes fewer than 30 days to complete.

Contact us today to learn more about how an annual health plan audit can protect both your practice’s liability and cash flow.

By CredentialingOne