OUR SERVICES

• Appeal Management: This service involves helping healthcare providers navigate the appeals process for denied insurance claims. Maximal Business Healthcare Services can provide support for first-level appeals, as well as second-level appeals, which involve more complex cases that require additional documentation and evidence.
• Charge Accuracy and Compliance: This service focuses on ensuring that healthcare providers are billing accurately and in compliance with all applicable regulations and guidelines. This includes reviewing charges to identify potential errors or overbilling and helping providers develop processes to maintain compliance.
• Coding/Clinical Documentation Improvement: This service involves working with healthcare providers to improve the accuracy and completeness of their clinical documentation, which can impact billing and reimbursement. This includes identifying areas for improvement, educating providers on best practices, and implementing processes to ensure accurate and complete documentation.
• Billing- Pre Billing and Post Billing Services: This service includes a range of activities related to the billing process, including patient registration, insurance verification, charge entry, claim submission, and follow-up on unpaid claims. This service can help healthcare providers streamline their billing processes and improve their revenue cycle management.
• Prior Authorizations: This service involves working with healthcare providers to obtain prior authorizations from insurance companies for specific procedures or treatments. This can involve submitting documentation and advocating on behalf of the patient to ensure that the necessary care is authorized.

• NPPES: The National Plan and Provider Enumeration System is a database maintained by the Centers for Medicare & Medicaid Services (CMS) that assigns unique National Provider Identifiers (NPIs) to healthcare providers.
• CAQH: The Council for Affordable Quality Healthcare is a nonprofit organization that provides a universal provider database called the Universal Provider Datasource (UPD) and a centralized platform for managing provider credentials and data.
• Availity: Availity is a clearinghouse that connects healthcare providers with health plans to facilitate electronic data exchange and streamline administrative tasks.
• PECOS: The Provider Enrollment, Chain, and Ownership System is an online portal maintained by CMS that allows healthcare providers to enroll in Medicare and manage their provider information.

When applying for health insurance provider enrollment or re-credentialing, you will likely need to go through several different steps and submit various forms and documents. This can include filling out application forms, providing proof of licensure and insurance, undergoing background checks and/or peer reviews, and more. The specific requirements will vary depending on the type of provider and the insurance plans you are working with.

If your application is rejected or denied, it's important to understand why and what steps you can take to rectify the situation. This might involve submitting additional documentation, appealing the decision, or addressing any areas of concern that were identified during the review process.

Clearinghouse registration and management can also be an important part of the enrollment process, as this allows you to exchange electronic data with insurance plans and other healthcare stakeholders. Availity is one example of a clearinghouse that offers these services.

If you need assistance with any of these processes, you may want to consider working with a healthcare consulting or management firm that specializes in provider enrollment and credentialing. They can help you navigate the complex requirements and ensure that your applications are submitted correctly and on time.