Site icon Billing & Credentialing Cranberry Twp. (Pittsburgh)

FAQ

How Important is Medical Credentialing to a Healthcare Provider?

Medical credentialing is a process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certification and skills to properly care for patients. It’s an essential function for hospitals and others which precedes hiring or obtaining coverage by an insurance carrier. Medical credentialing is perhaps most important because it’s the one method that permits patients to place their trust with utmost confidence in their chosen healthcare provider(s). Through a standardized process involving data collection, primary source verification and committee review by health insurance plans, hospitals and other healthcare agencies, patients are confident in their healthcare professional’s ability and experience.


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Do You Support Healthcare Providers that Perform Telehealth / Telemedicine?

Yes, we support medical providers who perform telehealth / telemedicine services. Virtual visits are an excellent way to boost your offices productivity and maintain your patient count. We can work with your established telehealth billing platform or help you set up a new one.


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What is Medical Billing?

Medical billing is the process in which medical providers are paid for performing procedures. The procedures are coded using the most current CPT and ICD-10 codes. The codes are then sent to the insurance companies on the proper HCFA 1500 forms for review and payment. It is the responsibility of the medical biller and coder to make sure the claim is coded correctly, submitted in a timely manner and paid to the physician. Reducing spend is the primary reason that medical practices elect to outsource their medical billing to a third-party provider.


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What is Medical Credentialing?

Medical Credentialing is the process of contracting with Insurance companies in order to become an in-network or approved medical provider for that company. Becoming a participating provider for insurance companies in your area is an extremely important part of any medical practice. Whichever companies you are contracted with will dictate which patients you are allowed to treat and what your reimbursement rates will be.


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What’s the Difference Between Medical Billing and Credentialing?

Medical billing and credentialing for medical providers are two different categories in the healthcare world. Before any medical billing can even be completed, the healthcare provider needs to be credentialed with insurance companies in order to be an approved provider of services. Becoming credentialed as an in-network provider dictates the set amount of reimbursement that provider can expect back.

After the credentialing process has been completed the healthcare provider is then able to start treating patients in that network and sending claims for reimbursement. A medical biller will use CPT and ICD-10 codes on the claim to describe to the insurance companies what treatment the provider has given. They will then follow up on the claim to make sure that it has been properly paid by the insurance company.

That’s the difference between medical billing and credentialing.


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What Insurers Have We Worked with in the Past?

Medwave Billing & Credentialing and its educated team of experts have worked with multiple commercial and government insurances.

We’ve worked with the following insurers:

  • Aetna
  • AARP
  • Align Network
  • Amerihealth
  • Anthem BCBS
  • Assurant Health
  • CHIP
  • Cigna
  • Consumers Life Insurance Company
  • Coventry One
  • Freedom Blue
  • Geisinger Health Plan
  • Health America
  • Health Net
  • Highmark BCBS
  • Horizon BCBS
  • Humana
  • Independence BCBS
  • Magellan
  • Medical Mutual of Ohio
  • Medicaid
  • Medicare, Novitas Solutions
  • Optum Health
  • Oxford Health Plans
  • Premiere Comp Solutions
  • Security Blue
  • United Healthcare
  • UPMC
  • UPMC for You
  • VBH
  • Veterans Association

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What are Our Rates?

Medwave and its team of medical billing and credentialing specialists understand the time and effort it takes to run an efficient medical office. That is why every office receives specialized attention and a tailored plan to help your practice succeed. Every contract is priced according to the needs of your practice and is always based upon volume.


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Do You Support Cannabis Medicine with their Billing Requirements?

*Currently, most major insurers and Medicaid / Medicare do not cover medical marijuana treatment, since cannabis is a controlled substance on the federal level. However, if you’re a medical marijuana provider and perform services that are covered by the aforementioned insurers (no matter what they are), then reach out to us. We’ve helped a number of groups get credentialed and bill for internal, alternative services.


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Do You Support Genetic Testing Labs with their Billing Needs?

Yes, we provide genetic testing lab billing services. Our team is experienced and well educated in the medical billing and coding guidelines of genetic testing lab specialists and has firsthand experience working with commercial and government companies to get your claims paid fast and efficiently.


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Do You Fix Denied Medical Claims?

Yes, once you contractually sign with us and we start your medical billing, we will analyze past claims as well. Those denied medical claims can be fixed and you will be paid out on them.


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Is A/R Recovery Part of Your Services?

Yes, Accounts receivables (AR) recovery is part of our services. In the last 16 years, our firm has resolved more than $100 million worth of insurance claims, in getting insurance companies to reimburse the amount due to health care providers.


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Which Regions do We Serve?

Although we serve the entire United States and Europe (as billing codes do not often differ), we target the Greater Pittsburgh Region. Generally speaking, this includes twenty-eight Pennsylvania counties, nineteen West Virginia counties, five Ohio counties, and two Maryland counties.

Outside of the Pittsburgh region, we service Cleveland, Ohio medical billing and credentialing, Philadelphia, PA medical billing and credentialing and Washington, D.C. medical billing and credentialing, Louisville, KY medical billing and credentialing, Phoenix, AZ medical billing and credentialing, Charlotte, NC medical billing and credentialing, etc,.


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What’s Your Medical Credentialing On-Board Protocol?

Providers and hospitals have many questions in reference to on-board medical credentialing protocol(s). The following blog post, Credentialing (On-Board Process for Providers, Facilities)  discusses our overall protocol in detail.


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Do You Partner with 3rd Party Medical Groups?

Medwave does partner with a number of 3rd party groups, especially medical product sales groups that have medical provider clients in need of credentialing and billing.


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Do You Provide Billing and / or Credentialing to Laboratories?

Medwave does provide billing and credentialing to laboratories of all types, but specifically Sleep Study Labs, Genetic Testing Labs and Toxicology Labs.


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