Managed Care & Enrollment

Provider credentialing and payor enrollment done with the click of a button.

Save time. Save Money.

For managed care organizations, provider credentialing and payor enrollment play a key role in the success of the organization. Unless a provider is credentialed properly and the application is submitted in a timely fashion, you cannot bill the insurance company.

The credentialing and payor enrollment process involve the collection and verification of provider’s information, using this information to populate application to various insurance companies, and tracking the enrollment process. MD-Staff’s extensive web crawling and online verification capabilities automate the credentialing process for large group of providers saving time and money. Adding to these functions MD-Staff MC incorporates additional features which are unique to the managed care environment such as enrollment, plan participation, and contract management.

Features

A single database

As a managed care organization you may have to fill out a large number of applications for your providers. MD-Staff ^MC has a comprehensive database which contains all the information needed to populate these applications. MD-Staff can populate any application in Word or PDF format. You can populate applications for one provider or for a group of providers with a few clicks.

Scanned documents

In addition to filling out the applications, MD-Staff ^MC paperless environment allows you to store important documents such as the DEA certificate, medical license, photo, CV etc. This will make the enrollment process quick and easy. Contracts with medical group or health plan can be scanned and attached for ease of access.

Extensive Reporting

MD-Staff ^MC contains an extensive library of built-in reports. These reports range from NCQA approved provider directory to provider participation. An ad-hoc query is included allowing you to export any data elements in MD-Staff to Excel.

Extensive Database

MD-Staff ^MC has an extensive and growing library of applications. Data from the MD-Staff database is used to populate these applications. With a few clicks, MD-Staff can fill out applications for one provider or a group of providers. This automation expedites the enrollment process.

MD-Query →

MD-App →

Virtual Committee →

E-Priv →

Provider Directory

MD-Staff ^MC generates provider directories in a format as required by Medicare. These directories can be posted on your public facing website. In addition MD-Directory can be integrated with your website allowing the public to search providers by specialty, office location and health plan.

Other features include

Customizable dashboard to track expiring credentials and pending tasks
Web based verification of licenses, DEA, OIG, SAM. Verifications can be performed for one provider at a time or as a batch
Verifications can be scheduled to run as a background job
Verification log to document the verification process
Automates the application management process
Populates applications from a single data source. The applications can be in PDF or Word format
Batch application processing. An application can be populated for one or many providers at one time
Customizable checklist to track the enrollment process
Provides over 200 management reports and NCQA style directory
Provides electronic provider look up which can be embedded into your website

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