Credentialing and Contracting Activities

 

Tier 1: $125 per insurance carrier per provider

Tier 1 Insurance Credentialing activities include adding a provider onto an already existing group contract. Initial group contract requests are a Tier 3 activity.

Tier 2: $175 per insurance carrier per provider

Tier 2 Insurance Credentialing activities include initial individual enrollments with Medicare, Medicaid (this does not include initial group enrollments with Medicare and Medicaid which is a separate Tier 3 activity) and any other individual enrollments with commercial payers that does not involve a group. Initial CAQH account setups are also a Tier 2 activity.

Tier 3: $275 per insurance carrier per provider

Tier 3 Insurance Credentialing is for applications with extreme or unknown complexity requiring extensive process management. All Group Practice Contract requests and enrollments are a Tier 3 activity.

Additional Services

 

Discovery Phase: $300 per provider

RMMS will reach out to up to 10 insurance companies to find the current status of your enrollment with them. Before we can work with you on obtaining or updating contracts it's important to know if you have an existing contract with the insurance company as an individual or if you are only currently considered in network because you have been added to another group contract. Some may already know what their standing is with insurance companies but if you do not we will reach out and do the work for you.

CAQH Update: $50 per update

CAQH Yearly Maintenance: $250 per provider for a 12 month period

RMMS will keep your CAQH profile up to date with your most current information, provide the required attestations, and send you reminders when there are pieces of your application that are due to expire (licenses, malpractice insurance, etc.)

Insurance Contract Maintenance and Revalidations: $75 per request

RMMS will manage requests from insurance companies to provide updated information. These requests will be delivered to you via email or USPS at which time you can forward to RMMS to handle.