Dealing with new enrollment contracts and closed panels has never been easier, thanks to our innovative and compassionate credentialing strategies. To find out how WCH Service Bureau has recently helped our client to become reinstated with a major insurance payer, read along. The story is told from the personal perspective of Dmitriy Yermolaev, our credentialing expert:
Two years ago, we took a client that has requested reinstatement with the UnitedHealthcare Community Plan of New Jersey.
The practice was terminated by UHC due to a non-renew clause, leaving the practice with limited options to reenroll and also causing a loss in a quantity of patients covered by this plan due to contract termination. From the very beginning, we knew that this case would not follow a standard credentialing appeal process and that time to expect the result wouldn’t be definite. WCH had set up several meetings with the UHC management team to discuss the reinstatement of the practice based on the location, level of care provided, and roaster of patients that wanted to receive care by this practice. In addition, we had also sent letters to the NY State Department of Finance to make a consumer complaint on UHC. We had worked even with local politicians to gain a letter of support from the community.
Continuous follow-up with UHC has made the payer’s network management department to overturn their initial decision in our favor, and grant the practice approval. Finally, this month, WCH has reinstated the provider with the UHC Medicaid line of business. This is a major accomplishment for our department to be able to deliver such a high level of results. The process was lengthy, but the ends have justified the means.
If your practice is in need of such credentialing results, contact our department, I am confident we can help your practice achieve clarity and comfort with the payers.