Frequently Asked Questions

What services does Apaana provide?

At Apaana we provide a 360° Service Suite across:

Credentialing | Enrollment | Medical Coding |Medical Billing | Revenue Cycle Management across organization types and most specialties.

We have worked with Individuals building healthcare organizations, Established practices start-ups across many states.

Will we have the access to an application tracking system?

Yes, Apaana-PULSE®, our analytics engine gives you the real-time status of your service requests with us. Additionally, Apaana Specialists are available and happy to meet with you as frequently as needed.

 

How long does the Credentialing process take?

The Credentialing process generally takes between 90-120 - 180 days depending on the insurance panel.

Private Commercials payors take more time if your National Healthcare Databases eg: CAQH etc is NOT up to date.

Getting profiles updated or created is a sensitive task and can be a primary reason for delays if not done properly.

Once you have selected the payor panels you would like, the onboarding process begins. Post this your applications are prepared and submitted. Our follow-up processes with payors are frequent and precise. Amongst other factors, our understanding of the process at the payer's end, makes sure that your credentialing applications are processed and approved faster with Apaana.

 

Does Apaana have experience in Credentialing providers in my area and specialty?

We have Credentialed providers across the nation!

No matter where your practice or facility is, we have the needed expertise to get you Credentialed and Enrolled. We Credential healthcare providers from Chiropractors to Anesthesiologists to Surgeons.

Do you do any pre-work for our service request?

Yes, depending on the services chosen from our 360° Services Suite:

Our approach to your service request is to manage it like a Professional Project:

We ensure that the breadth and depth of the practice is understood while building profiles in our systems.

For Credentialing & Enrollment besides conducting a verification process, we connect with the insurance panels for panel status and begin preparing applications. As requirements are insurance and state specific, there is no time wasted with this approach.

If the panels are closed, we ensure you are enrolled Out of Network, such that the billing process can be initiated.

 

Does Apaana specialize in Medicare and Medicaid Enrollments?

Yes, we do and not only that we are specialists in Credentialing | Enrollment with Medicare and Medicaid Advantage plans.

Additionally, we are well versed and experienced across Private Commercial Payers for your Credentialing, Enrollment and Re-Credentialing needs.

 

Do you provide assistance in acquiring the state business license?

Yes, we do assist with that.

We can also extend information and support in applications for Professional Licenses and DEA license modifications.

Where do you maintain Provider profiles?

We maintain Provider, Group and Facility profiles on Modio systems. Besides this to keep your profiles updated we perform regular maintenance on CAQH.

If I’m not approved, what happens next?

Unfortunately, we cannot guarantee that a Group / Facility / Provider will be accepted into the insurance network as that decision lies with the insurance panel.

However, if you are not approved for participation, we will either follow through with an appeals process (if the panel has one) or we will wait until the next quarter to submit a new application when the panel opens.

In the meantime, we will enroll you as an Out of Network Group / Facility / Provider so you can start billing and not loose revenue.

Do you help a healthcare startup with getting credentialed?

Yes, we do Credentialing and Enrollment for start-ups. We also assist in LLC creation services via an alliance partner who specializes in this activity.

What types of healthcare organizations do you work with?

We work with an array of organization types and healthcare professionals.

A few identifiers in no specific order of priority: Clinical Laboratories, Ambulatory Surgery Centers, Multi-Specialty Practices, Telehealth Service Providers, Mental Health Practitioners amongst others.

Do you offer Enrollment services to the groups who are in the process of merging?

Yes, we provide services to groups going through a merger.

What are the steps you follow for timely Credentialing & Enrollment?

We have a very simple and streamlined onboarding process which includes finalizing the right insurance panels if not already done and building profiles for Group / Facility / Providers in our systems. Once additional documents have been uploaded we prepare applications besides initiating an automated PSV process.

What will be required from us for effective Credentialing & Enrollment?

Please keep a good eye on your email inbox and accept our requests for an initial online meeting.

Initially, we need the bare minimum of information from you and once we analyze your online profiles in Healthcare Databases we will get back to you with what else is needed to complete your applications.

Will I get a Dedicated Account Manager (DAM)?

Yes you will, and not only that an Apaana Specialist will also be working on your service requests with us.

National Healthcare Database: CAQH

Is an updated CAQH profile mandatory for most payers?

Yes, in today’s scenario all private commercial payers use CAQH profiles as validation points for Credentialing and Enrollment.

Credentialing And Enrollment

What is Provider Enrollment?

Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their Provider panels. When a Provider has been approved to become a Participating Provider, the next phase begins. i.e. the Contracting phase.

Why do you need Credentialing and Enrollment?

To put it simply, you get to see more patients. If you have enrollments across a larger number of Insurance panels and have the participating status you can see them without high co-pay.

How much does Credentialing & Enrollment cost me?

Our per-application pricing depends upon volumes. If they are a larger number of insurances then you get a good discount.

Our per-application cost ranges from $130 to $200 per payor application. Besides this, we have a setup fee or Provider / Group / Facility that allows us to build their profiles with no room for error.

When do Credentialing and Re-Credentialing occur?

Credentialing happens before a provider is considered eligible to participate in an insurance network. Re-Credentialing is done every 1-3 years after the original effective date of the Provider to make sure that all of the information listed with the insurance panel is up to date and accurate.

What is Delegated Credentialing?

Delegated Credentialing is done when groups are large enough (such as hospitals or universities) the payors can grant an addendum to a contract allowing the group to maintain their own Credentialing. This saves time since the payors can be inundated with applications and get backlogged. With Delegated Credentialing, the group or its contracted company is responsible for completing the primary source verification process typically performed by the insurance company. It’s the responsibility of the delegated entity to ensure that all providers meet the standards as set forth by the insurance company. Once the provider is Credentialed at the facility (such as a hospital) the entity would send each delegated payer a roster (typically once a month) showing all employed Providers and any new additions since the last report.

How do I obtain a CAQH ID number and what does maintenance entail?

Almost all private commercial insurance panels will require providers to have or obtain a CAQH ID. If you don’t already have one, we are able to create one for you! Let your specialist know and we’d be happy to add it to your project. Every four months, you will receive a request from CAQH to re-attest that all of the information in your application is correct.

Do I get to choose the panels I want to be on?

Yes, you get to choose exactly which panels you want, and don’t want, to be credentialed with. If Panels are closed we offer replacement panels at no extra cost.

What insurance panels should I choose to enroll with?

We can help! An Apaana Specialist can help with some recommendations,  your decision on the panels is final and we will go with that. Our recommendations on panels come from ncqa.org besides other sources.

How do insurance panels gather credentialing and enrollment data?

Many Private commercial insurance panels will take the information from your CAQH profile in order to initiate the process.

If a provider submits an application on the payor website for the respective panel, the application will go through the process and the private commercial payor panel will typically access your CAQH profile to verify the information on your application.