Managed Care Contracts, Provider and Facility Credentialing

Managed Care Contracts: Analysis and Negotiation
Please contact us to learn more about PPS review and analysis services for managed care contracts, fee schedule analysis, and contract negotiations. Following is a brief description of these services; custom options are available.

Contract Review and Analysis
The PLATINUM Physician Services, Inc. contract summary outlines the key aspects of each managed care contract. We review managed care contracts to identify terms, including effective dates, termination dates, and claim filing and payment guidelines. We also identify managed care contract terms that would be considered a disadvantage to the medical practice.

Fee Schedule Analysis
Managed care contracts typically present reimbursement rates in plan-specific ambiguous language, leaving your medical practice without a clear understanding of the actual reimbursement rates. In addition, the plan-specific terminology prevents your practice from an “apple-to-apple” comparison of your managed care agreements. The PPS fee schedule analysis identifies the code specific reimbursement rates for each managed care contract and outlines a plan-by-plan comparison.

Managed Care Negotiations
Negotiating managed care agreements requires an extensive knowledge of the managed care contracting process and environment. PPS guides clients through this process, identifying negotiable terms and practical timelines.

Provider and Facility Credentialing
For the typical medical practice, managed care provider and facility credentialing is a tremendous workload drain, requiring dedicated attention and skill to administer and track effectively. If your medical practice lacks a full-time credentialing specialist, you may be experiencing costly delays, wasted time and negative impact on profits and productivity. You can more efficiently process, manage and track all credentialing paperwork and supporting documentation for your medical practice with our help. PPS provides a comprehensive, centralized provider and facility credentialing service.

We will complete all credentialing paperwork related to both managed care participation and facility appointments. Our Credentialing Solution completes and manages:

• Initial provider applications
• Re-credentialing applications
• Provider profiles
• Provider updates
• Facility appointment applications
• Re-appointment applications
• Medicare applications
• License updates and renewals
• W-9s
• Confidential information reports
• CAQH

Complete Credentialing Solution
The PPS credentialing solution ensures timely submission of all applications, status reports of application progress, and tracking of all CME records and license renewal dates. Clients need only review and sign off on documentation.