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Challenge

Credentialing and enrollments for new providers were taking too long to process, costing Hometown Pediatrics of Joplin time and money.

Solution

The practice chose OP’s Credentialing and Enrollment Service for its deep expertise in pediatric credentialing and specialized knowledge of payer rules and requirements.

Results

Providers were able to get credentialed across all of their payers within 90 days, shortening the turnaround time of their previous service by 50%.

OP really excelled with our credentialing. It cut the process time in half.

Mandy Arterburn, Practice Manager, Hometown Pediatrics of Joplin

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Credentialing and Enrollments Made Easy: The Key to Faster Onboarding and Revenue 

 

For many pediatric practices, the credentialing and enrollment process can be a major bottleneck when onboarding new providers. Lengthy turnaround times mean practices can’t bill for those providers’ services, resulting in significant revenue loss. Hometown Pediatrics of Joplin, a six-provider practice in Joplin, MO, had long struggled with this challenge. Knowing a new provider needed to be credentialed quickly, the practice turned to OP Credentialing and Enrollment Services for help.

Time is Money 

Hometown Pediatrics of Joplin struggled with lengthy credentialing and enrollment times with their previous credentialing partner. The process often dragged on for 180 days, which had a significant impact on their revenue. Additionally, the practice lost revenue because some providers were not credentialed properly. Mandy Arterburn, the Practice Manager, elaborated on the challenges: “Our major payer is Anthem Blue Cross Blue Shield, and we’ve faced some hurdles working with them. There can be delays with claims processing, denials, and the credentialing process in general. While they indicate a 90- day time frame for credentialing new providers, it often takes closer to six months.” These delays equate to a significant loss of potential revenue that no growth-minded practice can afford.

Faster Onboarding and Revenue Growth

In 2023, Hometown Pediatrics switched to OP for all its revenue cycle management needs, including credentialing and enrollments. OP’s specialization in pediatric billing and credentialing were key factors in the decision. The results were immediately transformative. The practice experienced significantly faster credentialing turnaround times across multiple payers, including their leading payer, Anthem Blue Cross Blue Shield. “We hired a new nurse practitioner in October who was fully credentialed with OP faster than the one hired three months earlier with our previous company,” Mandy said. “OP really excelled with our credentialing. It cut the process time in half.” OP’s credentialing expertise accelerated the practice’s revenue cycle, expanded patient access, and ensured they got fully reimbursed for their services from the start.

Dotting I’s and Crossing T’s

OP’s seasoned credentialing team is well-versed in the intricate details of payer applications and industry rules and regulations, so submissions are precise and error-free. This, in turn, minimizes rejections and delays. A proactive approach with regular monitoring and timely follow-ups keeps credentials up-to-date, preventing costly deactivations that can lead to denied claims and lost revenue. Mandy concurs. “OP Credentialing has streamlined our workflow. They’ve been very hands-on and knowledgeable, providing step-by-step detail, and always letting us know where they are in the credentialing process. And it’s just been wonderful. I don’t know why we didn’t do this sooner.”

With OP’s Credentialing and Enrollment Services, practices like Hometown Pediatrics of Joplin can relax, knowing their credentialing and enrollments are handled accurately from start to finish. We do this by eliminating administrative headaches, keeping revenue flowing, and allowing pediatric practices to prioritize what matters most. And really, who doesn’t want more time back in their day?

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