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Credentialing & Enrollment Services
VantagePoint’s expert credentialing specialists understand the Medicare, Medicaid, and commercial health insurance enrollment and credentialing process requirements, making our team members highly effective and efficient. We also provide on-going credentialing monitoring services to keep providers participating with the insurers and on staff with facilities: tracking deadlines, expiration and renewal dates, as well as all re-credentialing requirements.
Commercial Insurance Provider Enrollment and Credentialing
Medicare and Medicaid Provider Enrollment and Credentialing
Managed Care Contracting Issues
Hospital privilege applications and reappointments
Medical License Application Processing and Tracking
VantagePoint has experience performing credentialing and enrollment services for all types and specialties of healthcare providers, including:
Independent Physicians & Medical Groups
Nurse Practitioners & Physician Assistants
Urgent Care Facilities
Telemedicine & Telehealth providers
Behavioral Health and Substance Use Disorder Providers
Physical, Occupational & Speech Therapists
Labs, ASCs & Imaging Facilities
FQHCs & Rural Health Clinics
Hospice, Home Health, and Skilled Nursing Facilities
Hospitals & Health Systems
Primary Source Verification
Achieving CVO certification from NCQA demonstrates that VantagePoint has the systems, processes and personnel in place to thoroughly and accurately verify your providers’ credentials. As a fully certified NCQA Certified Credentials Verification Organization, VantagePoint staff is trained in performing primary source verification according to stringent NCQA standards.
Insurance Contract Negotiation & Contract Evaluation Services
VantagePoint can assist physician practices, facilities, or any new healthcare business in negotiating their contracts with commercial payers. VantagePoint can also assist with contract re-negotiations and evaluation of current insurance contracts.
Our contract evaluation and re-negotiation service for established healthcare providers and organizations includes:
Reviewing and analyzing all current agreements
Evaluate payer agreements, compare to regional market standards.
Propose a contracting strategy based on business goals and the current insurance climate
Determine whether capitation, exclusivity, preferred provider status, pay-for-performance is available with any payers.
Develop and implement a plan to renegotiate current insurance agreements.
CAQH Maintenance & Ongoing Exclusion and Sanctions Monitoring
A critical component to keeping providers actively enrolled with payers is to make sure their credentialing documentation is kept current. VantagePoint clients benefit from our high value, high touch approach to monitoring for expiring licenses, DEA or CDS registration, board certification(s), as well as professional liability insurance. Additionally, we will ensure CAQH is updated as needed or as required every 120 days.
As a compliance-focused consultancy, VantagePoint encourages all our credentialing and enrollment services clients to maintain an ongoing exclusion and sanctions monitoring regimen. From the OIG exclusion list , to SAM and State Medicaid sanctions monitoring, VantagePoint can take care of this important compliance obligation on behalf of our healthcare credentialing clients.
Increasingly, healthcare organizations of all types are pursuing creative approaches to managing credentialing and enrollment processes, including insourcing previously outsourced services, full or partial outsourcing, accreditation, and delegated agreements. Organizations often need temporary support for new credentialing department set-up, policy and procedure development, project management for full or partial outsourcing transitions, establishing a credentialing committee, or improving existing credentialing department operations.
Through our first-hand experience as an NCQA-certified CVO providing credentialing and enrollment services for clients across the continuum of care, as well as our deep bench of compliance and revenue cycle consulting expertise, VantagePoint is uniquely positioned to offer Credentialing Consulting services.
Our services are structured to be compliant with NCQA credentialing standards. VantagePoint is fully Certified by NCQA for 11 out of 11 verification services and meets NCQA’s credentialing standards for health plans. Achieving CVO certification from NCQA demonstrates that VantagePoint has the systems, process and personnel in place to thoroughly and accurately verify providers' credentials and help health plan clients meet their accreditation goals.
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