Frequently Asked Questions
Managed Care Contract & Consulting Services
It depends on the health plan and on a variety of other factors that contribute to the process of obtaining a contract. Mix Solutions has experience with many health plans across the nation and we have a credentialing department in place ready to assist you. Due to our connections with those health plans, it could be a much faster process as we know exactly what documents are required. We can check to make sure your documents are correct to save time and rejections. Mix Solutions contracts tend to get moved to the front of the line which means good news for our clients.
what is credentialing and how long does it take?
Process by which a health plan verifies facility documentation for contracting efforts. That depends on which health plan because some may require different documents than others when submitting the credentialing application. No matter what, you will always need to have a Request for Taxpayer Identification Number and Certification (W9), facility license, survey from Department of Health Services/CMS, and a Certificate of Liability Insurance (COI).
How often do I need to bill the health plan?
The norm within our Skilled Nurisng Facility (SNF) industry is to bill once a month but some plans allow for drop billing.
Are the claims submissions strict on timelines?
The answer is Yes. You should check with every health plan on what the timelines are. They vary with each health plan, so be careful and make sure you read the contract carefully. Mix Solutions will let you know these timelines when we prepare contracts for you.
Do all health plans offer the same rates?
The answer is NO! Please call to talk to a Mix Solutions consultant about this question! You could be losing a lot of money on every patient if you do not pay attention to this.
How long does the health plan have to pay the claim?
This varies again, but typically, if you have submitted a “clean claim” meaning all codes/levels are correct, then you can expect the payment to be about 45 business days after they receive the claim.
What systems need to be in place when working with Managed Care?
Give Mix Solutions a call and we can help customize your facility's managed care system.
Fill out an Online Request Form