A recent MultiPlan audit performed on Primoris Credentialing Network’s delegated provider enrollment policies and procedures in March 2022 showed that Primoris’ policies and procedures were found to be complete and meet all requirements for:
- Credentialing
- Recredentialing
- Appeals
- Ongoing monitoring
- Provider rights
- System controls
Primoris Credentialing Network and MultiPlan have a solid partnership. MultiPlan is on the impressive list of delegated contracted companies and Primoris’ 54+ health plan and network provider enrollment options.
MultiPlan Audit and The Importance of Provider Enrollment Audits
Suppose a company like Primoris has a delegation agreement with a private healthcare insurer or government payor for primary source verification or provider enrollment. In that case, they can expect to receive a delegated oversight payor audit each year. These audits, such as the MultiPlan audit, gauge how well a company complies with payor and accreditor regulations.
MultiPlan evaluated Primoris in the following areas:
- adherence to certifying body standards,
- data management technology security,
- information handling policies and procedures, and
- roster quality and accuracy.
These audits help ensure that providers are being correctly credentialed. Inadequate credentialing can result in providers with histories of malpractice slipping through and being allowed to treat patients. It can also result in providers being denied enrollment despite having no history of negligence.
MultiPlan Audit: One of Many Successful Audits
The MultiPlan audit of delegated provider enrollment is only one of the recent audits that Primoris has passed. When HealthSmart audited the company in December 2021, Primoris scored 100% in every area they were assessed. This latest achievement further demonstrates that Primoris’ reputation as the largest credentialing independent physician association in the Midwest and one of the largest in the country is secure and growing.
The Primoris team continues to put their 387+ years of industry experience to skillful use. Our mission to give providers smarter, simpler, and better enrollment becomes more robust with every network they add to their roster.
MultiPlan + Primoris: The Power of Delegated Contracts
Delegated contracts result in faster provider health plan enrollment, which means providers can start billing sooner rather than later. Delegated contracts allow Primoris to use one application to add a provider to multiple plans and networks much faster than sending an application to each plan. Primoris is the largest IPA in the Midwest, offering 54+ health plan and network provider enrollment options and delegated by most major plans in Oklahoma. Always looking ahead, the IPA is adding dozens of other plans in Illinois, Missouri, and Texas.
Primoris’ current delegated health plan enrollment options include:
- Aetna
- GlobalHealth
- HealthSmart
- Humana
- Longevity Health Plan
- Prime Health Services
- United Healthcare
- and more
Primoris’ current non-delegated and entirely administered health plan enrollment options include:
- BlueCross BlueShield of OK
- CareATC
- Community Care
- Integris Health
- Medicare
- TriCare
- TriWest
- US Department of Veterans Affairs
- and more
Providers who are enrolled in MultiPlan can enjoy access to a web portal that enables them to:
- Access lists of clients.
- Acquire and send group rosters.
- Add providers to a group.
- Check application and request statuses.
- Request contracts, fee schedules, and rosters.
- Submit billing and network questions.
- Update demographics.
- Verify provider network participation.
Providers can also register for web portal training and access downloadable handbooks. These documents contain detailed information such as credentialing, reimbursement, and dispute resolution. Providers can also use the FAQ on MultiPlan’s website. This easy-to-read resource answers questions regarding application requests, benefits, and claims. Providers can also learn how to request contract copies and apply for grants.
About MultiPlan
For 40+ years, MultiPlan has helped its clients save $19 billion+ annually via advanced healthcare cost management solutions that highlight equality, efficiency, affordability, and a legacy of solid provider relationships. Their client base includes all 10 of the United States’ top 10 healthcare payors by market share.
MultiPlan works side-by-side with healthcare payors to forge cost-effective solutions for them. The company’s history of contracting with healthcare providers allows them to offer accommodating provider networks to commercial, government, property, and casualty payors.
MultiPlan’s advantages include the following:
- Decreasing the risk of patient migration due to network coverage issues.
- Granting access to a varying population of payors.
- Improving cash flow.
- Lowering collection costs.
- Offering contracted network reimbursement and timely payment provisions.
- Reducing patients’ out-of-pocket expenses.
About Primoris Credentialing Network
Primoris Credentialing Network is a member of the Fifth Avenue Healthcare Services family of companies that offer 54+ health plan and network provider enrollment options. Founded in 2010, Primoris has utilized some of the healthcare industry’s finest technology and people to help place medical providers onto insurance plans and networks so providers can start receiving payment for their services.
Primoris is the largest credentialing IPA in the Midwest and strives to be the largest credentialing and provider enrollment IPA in the United States. The company also aims to achieve annual retention metrics of 90%+ and provide a safe, welcoming environment that rewards accuracy, collaboration, and diligence.
More information about Primoris Credentialing Network
Primoris Credentialing Network is an NCQA Credentialing Accredited specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
Primoris Credentialing Network originally published this article here. For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
