Credentialing Process
- 2. About Us: CREDENTIALS VERIFICATION ORGANIZATION The credentialing process for a doctor’s office, provider network, or hospital can be one of the most expensive budget items. Med Advantage has been working diligently to expedite the process and reduce the cost to credential a provider through the use of automation, large data centers, and a proprietary process & software. CREDENTIALING / RE-CREDENTIALING: Med Advantage has developed and actively maintains a proprietary database containing verified records of over 970,000 individual healthcare providers who have been credentialed by the company at least once, as well as a data warehouse which links together 98 primary data sources and contains information on over one million healthcare providers. The database includes providers in all 50 states, the District of Columbia and the Commonwealth of Puerto Rico. The company’s size combined with its data management and verification capabilities make Med Advantage one of the leading companies in the CVO industry and the only one that is independently owned.
- 3. SERVICES ELECTRONIC CREDENTIALING SERVICES Med Advantage provides online services to Managed Care Organizations who can register online and search our database of over 900,000 medical providers (MD’s & DO’s). Med Advantage’s online service contains the following information for verifications which is updated every 90 days. The information meets all requirements for The Joint Commission, NCQA and URAC since the information is compiled from the American Medical Association (AMA), The American Board of Medical Specialties (ABMS), The National Technical Information Service (NTIS), the Department of Health and Human Services (DHHS), and the respective state licensing boards. Graduation From Medical School Primary source verification from the medical school. Graduation from Internships, Residency’s and Fellowships Primary source verification from post graduate education. Board Certification Primary source verification from The American Board of Medical Specialties. Valid DEA Certificate Primary source verification from the DEA records certification. Department of Health and Human Services Medicare/Medicaid Status Primary source verification from DHHS Cumulative Sanction Report. Current Valid License Primary source verification of current license and sanction from the state licensing board.
- 4. APPLICATION MANAGEMENT A company’s credentialing process begins with a request for credentialing or re- credentialing of a specific provider or group of providers. As part of the request, the client generally extracts selected provider data from its internal information system in a usable format. Med Advantage’s proprietary credentialing system then automatically converts the data into a usable format and matches the data with the information in the data warehouse. The matched data is merged into the company’s database to begin the application process. Data extract requests are an efficient way to credential large numbers of providers with minimal administrative effort – saving you time, money, and resources.
- 5. NETWORK DATA SERVICES Med Advantage, along with its data partner, delivers a proven, powerful software solution designed to ensure the accuracy of healthcare and insurance payers’ provider databases and maintain the information on an on- going basis. Services are performed through a secure, hosted web service (ASP) that scrubs payers’ internal provider file data to identify inaccurate and incomplete information. We can enhance your files with information from our comprehensive database of provider data, which includes primary source- verified data of office-based physicians, practitioners, hospitals and facilities, business entities, pharmacists, pharmacies, ancillary providers, and organizations. Data services reliably matches and joins data from different sources. Providers are tracked across time, including changes in address, name, license status and affiliations. In addition, this service is actionable and it calculates match scores for automatically interpreting and implementing results based on client-specific rules.
- 6. CONTACT US: CONTACT INFO 12001 Science Drive, Suite 115 Orlando, FL 32826 Phone: 407-282-5131 Fax: 407-282-9240 Email: info@med-advantage.com Web: med-advantage.com