The appropriate credentialing of current and prospective CVCP physicians is a key component of a complete Quality Management Program. Credentialing is the systematic evaluation and verification of physician training, licensure, and experience performed to ensure the delivery of appropriate and efficient patient care by fully licensed and qualified physicians. This process is performed in compliance with the standards of the National Committee for Quality Assurance (NCQA) and the Department of Insurance.
CVCP makes credentialing easier for providers through our delegated credentialing agreements with the payers. Each provider only has to complete one credentialing application with CVCP and it is then applied to all applicable contacts. This process simplifies credentialing for the medical group.
Before a patient is seen for treatment, the first line of communication between your office and CVCP is our Pre-certification Department. In order to eliminate the front end headaches and burdens in your practice, CVCP's pre-certification department is set up to perform the following functions for you: obtain patient eligibility, plan benefits, obtain pre-authorization of services from the health plan, and assist the patient in obtaining a PCP referral. These services are done for each patient occurrence whether inpatient, outpatient at the hospital, or outpatient in your office. We hope you find this a great service to your practice.
Billing
CVCP does ask provider offices to provide a Claims Manifest upon submission of claims. The Billing Department uses this manifest to verify receipt of your claims; they sign and date it and fax it back to your office for your records.
CVCP enters your claims and reprices them into the appropriate packaged price within two days from the receipt of the claim in our office. In fact, many of the outpatient claims go out to the payer the same day as they are received. All claims under our current contract with your office are billed electronically to the payer daily.
Insurance Follow up and collection
All claims for which payment has not been received from the payer are automatically placed on a collection tickler at 30 days from CVCP's claim filing date. At the 30 day mark, our collections team contacts the payer for status of payment of the claim and then continues the collection process until the account is paid in full.
During our collection process with the payer additional information, such as medical records, may be requested from your office. CVCP will contact your office by telephone or in writing depending on the nature of the request.
When you have status questions regarding your provider's charges, your first contact should be with our Provider Relations Representative. However, our collectors can assist you with urgent status questions otherwise the majority of their time is spent on the phone with payers.
Historically CVCP has had a wonderful collections rate with our payers; our accounts receivable over 120 days is currently only 2.5% and only 1.1% in the 91-120 range. The majority of our A/R is current and we keep it that way!
Check processing and 1099s
Once payer payments are received by CVCP, the Finance department is responsible for posting these payments and any adjustments to the appropriate patient accounts. Provider payments are issued weekly through the Finance Department.
In the event of an overpayment by a payer, you may also receive requests for refunds from the Finance Department.
Questions regarding clarifications on the explanation of benefits, provider payments, refund requests and EOB analysis/training may be forwarded to the Finance representatives for resolution.
