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Your Partner in Provider Credentialing and Payer Enrollment

TriumpHealth is a full-cycle revenue cycle management company, that specializes in providing exemplary provider credentialing and payer enrollment services to providers of all specialties nationwide. Whether you are a doctor, nurse practitioner, behavioral health provider, DME company, dentist, or FQHC, TriumpHealth has the knowledge and expertise to confidently help your organization. With an unwavering dedication to optimizing revenue cycle process, TriumpHealth is committed to assisting healthcare providers maximize payer reimbursement while prioritizing the delivery of exceptional patient care.

While understanding the pivotal role of provider credentialing and payer enrollment in higher reimbursement and operational efficiency for healthcare practices, TriumpHealth offers a comprehensive suite of these services tailored to meet the diverse needs of its clients.

Provider Credentialing Services

TriumpHealth’s provider credentialing services are crafted to streamline the credentialing process, ensuring that healthcare providers are credentialed with payers in a timely manner resulting in faster revenue realization. From the initial application submission to ongoing maintenance and re-credentialing, the team at TriumpHealth adeptly manages the entire credentialing lifecycle. They alleviate administrative burdens and minimize delays in reimbursement, allowing healthcare providers to focus their energies on core patient care responsibilities.

Furthermore, TriumpHealth facilitates seamless payer enrollment for healthcare providers, enabling them to actively participate in various insurance networks and broaden their patient base. Their dedicated team handles all aspects of payer enrollment, from application submission to contracting, and subsequent negotiations, ensuring that providers are enrolled with the right payers to maximize revenue opportunities.

TriumpHealth extends its expertise beyond provider credentialing and payer enrollment to encompass Electronic Data Interchange (EDI) and Electronic Funds Transfer (EFT) enrollments with payers as well. EDI facilitates the electronic exchange of transactions, such as claims, remittance advices, and eligibility inquiries, between providers and payers, thereby streamlining administrative processes and expediting reimbursement. EFT, on the other hand, enables secure electronic transfers of funds directly into providers’ designated bank accounts, enhancing financial efficiency and reducing reliance on paper-based payment methods. Despite the pivotal role of EDI and EFT in optimizing revenue cycles, many providers overlook the necessity of enrolling for these services with payers, mistakenly assuming that traditional payment methods suffice.

TriumpHealth recognizes the critical importance of EDI and EFT enrollments in ensuring prompt and electronic reimbursement from payers and offers comprehensive assistance in navigating this often-overlooked aspect of the payer enrollment process.

Steps of the Credentialing Process

  1. Information Collection
    State licensing boards are responsible for issuing licenses to healthcare professionals and maintaining their records. They are an essential source of information for primary source verification, as they can confirm a professionals education, training, and licensing history.
  2. Information Review
    The TriumpHealth credentialing team checks for the completeness and accuracy of all information the client uploads. If any information is missing or outdated, we will notify the provider of what additional documentation is needed to complete their applications for each payer.
  3. Letter of Interest Submission
    Our credentialing specialists create a letter of interest (LOI) for each payer and submit them on each provider’s/practice’s behalf.
  4. Application Creation
    Our credentialing specialists complete each payer application with all necessary information provided by the client.
  5. Application Submission
    The applications are submitted to the payers, and an answer regarding if the markets are open or closed should be received in 30-45 days.
  6. Follow Up
    Our provider enrollment and credentialing services follow up on each application regularly and provide monthly updates to the client. The persistent follow-up process that we have implemented allows us to hold payers accountable for the work that needs to be done on the applications.
  7. Acceptance or Denial
    A final decision regarding a provider being accepted into the network is made by the payer enrollment, and the internal filing process for the payer begins. Once the internal filing is complete, the provider will be able to bill out according to the contracts obtained. In the case of a denial, our credentialing specialists can appeal to a payer up to 3 times for a client.

TriumpHealth and AdvancedMD Partnership

TriumpHealth is proud to partner with AdvancedMD, a leading provider of cloud-based practice management and electronic health record (EHR) solutions, to enhance the credentialing process for their clients. Through this strategic partnership, AdvancedMD clients can leverage TriumpHealth’s expertise in provider credentialing and payer enrollment to streamline administrative workflows, expedite reimbursement, and improve overall practice efficiency.

By integrating TriumpHealth’s specialized credentialing services with AdvancedMD’s innovative technology platform, practices gain access to a seamless solution that automates credentialing tasks, reduces manual errors, and increases velocity of reimbursement. This synergy between TriumpHealth and AdvancedMD empowers healthcare providers to focus on delivering high-quality patient care while optimizing financial performance.

Contact TriumpHealth Today

Inquiries are welcomed by TriumpHealth, and interested parties are encouraged to fill out the form above. The team at TriumpHealth stands ready to provide tailored solutions and unparalleled support to healthcare providers seeking to navigate the complex landscape of provider credentialing and payer enrollment with confidence and ease.

Category: Practice Operations | Software Type: Medical Billing

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