What is Smart Start Package?
Customers can choose to use the full Kareo platform or another partner software and Health Prime's RCM service. The Smart Start is a program designed for new practices just starting out which includes both billing and credentialing services as a bundle.
If selecting Kareo, the Kareo PM billing, EHR Clinical and Engage software is included in this bundle. Other applications may come with minimal fees but each (other than Kareo) will need to be evaluated for cost, licenses HPI may hold, etc.
The fee is $1000/month for the first 6 months, starting the first month. Then in month 7 (Or whenever the account begins actively billing) the billing fees take effect. This fee is either the monthly minimum of $2000 or the percentage of collections; whichever is greater. Billing does not necessarily have to wait until the customer gets contracted (if it is decided they want to see patients OON or specific payers only its their prerogative), but many customers/ providers elect to continue working in their previous positions until they are fully credentialed.
Note: Even to bill OON Providers must wait until payers have credentialing information on file to bill since without this payers do not know who these providers/ offices are. If you have any questions, please don’t hesitate to reach out to credentialing@hpiinc.com or Helpme@hpiinc.com for clarity. There are no silly questions, so please ask. (Please see attached Smart Start Flyer)
When does credentialing begin?
Smart Start credentialing does not start the moment they sign up with Health Prime Smart Start or sign an a la carte agreement for that matter. Prime Credentialing cannot start any credentialing until the following takes place:
- The customer provides us basic practice information so we can set up or assist with setting up the software account (depending on the application selected)
- The customer must sign up for ACH with accounting so that we are able to collect payment for services from them.
- The customer provides ALL supportive and relevant documents requested by credentialing. (NOW we are using Modio so customers are provided a link so they can enter and upload all required data)
- Prime Credentialing will not start any applications, LOIs, etc. until the practice and their providers give us all required documentation.
- Prime Credentialing will NOT submit applications with missing or incomplete information.
A payer list is part of the credentialing intake and requirements. The customer must provide a list of all payers they wish to be credentialed or contracted with during intake, no exceptions.
If the customer has questions on which documents are required or clarification on any documents Health Prime is requesting, our credentialing intake/ onboarding team is here to help.
Once all required information is input and loaded in Modio, our credentialing intake department does an audit/review to ensure nothing is missing. Sometimes, we find there may be an expired document, conflicting address information, missing peer references, date gap, etc. that can result a rejection and we communicate back with the customer. Once the audit is completed the account is then assigned to a Credentialing Account Manager (CAM) to begin the LOI/ application process for submission. Follow up is also conducted by the CAM and communicated back to customer periodically.
How long does it take to get credentialed?
The short answer is to set the expectation as 4-6 months minimum from application submission. And, it varies from customer-to-customer, specialty and state. There are many factors to consider:
- How quickly does the customer submit all the required paperwork to Prime Credentialing via Modio? What is the quality of that paperwork and the information provided?
- Payer turnaround time varies (backlogs, specialty priorities, insurance consolidation/TPA changes).
- Payer may have forwarded queries regarding the applicant to a third-party.
- Payer is, or is not, accepting new applications for that specialty in a particular market.
The best thing we can recommend for customers is to make sure that the practice/provider(s) has an alternate source of income while credentialing is in process.
Does Prime Credentialing negotiate rates?
No. When a practice is offered a contract, the rates will be forwarded to the customer as part of that payer contract for approval & signatures. Prior to signing and accepting rates these should be thoroughly reviewed by the practice administrator and negotiations should take place if not in agreeance with said rates. This is the sole responsibility of the practice, Health Prime will not do this for any contract.
How are rates determined by a payer?
Typically, the insurance will offer a provider or practice the standard rates that they offer all providers of a particular specialty in a given market. Therefore, it is very important for practices to provide us any relevant information to provide to the insurance company that differentiates what they do and reduces cost. However, without historical practice data, it is very hard for an insurance to justify a new practice to receive a premier rate. It is recommended that a new practice be available to as many insurances as possible so as to not limit the referring physicians from sending patients when they are first starting out. Once the practice has solid operations and an established source of new and existing patients, they should review low payer rates and submit requests to negotiate directly to the payer.