Credentialing
GPCA staff works with FQHCs on how to follow credentialing verification standards set by the National Committee on Quality Assurance (NCQA) and the HRSA. In addition to application processing and primary source verification, the GPCA can assist FQHCs with monitoring expiring documents and licenses (DEA registration, insurance certificate, licenses). The GPCA obtains new documentation from providers as well as monitors the HHS Office of Inspector General Medicare/Medicaid, sanctioning reports and state licensing board disciplinary actions.
The GPCA will also assist FQHCs in the form of reviewing credentialing P&P, making any necessary updates, auditing credentialing files for accuracy and completeness. GPCA staff also participate in the file review portion of site visits, both virtually and in person.
https://bphc.hrsa.gov/compliance/site-visits/site-visit-protocol/clinical-staffing
If you need assistance with credentialing, please complete this form. We will be in touch with you shortly.
Provider Enrollment
Provider enrollment is a critical process. If your providers are not enrolled correctly, you will not be paid for services provided. GPCA staff works with providers to determine which insurance carriers and networks they would like to pursue participation status with. These carriers may include Medicare, Medicaid, commercial carriers, and workman’s compensation carriers. Additionally, GPCA staff works with FHC providers on keeping their CAQH database up to date. GPCA staff can also assist with completing the enrollment application. In addition, GPCA staff work with FQHCs on how to obtain fee schedules from contracted carriers to be utilized in the billing process. GPCA staff will also provide TA for those having reimbursement problems due to enrollment issues.
https://pecos.cms.hhs.gov/pecos/login.do#headingLv1
https://nppes.cms.hhs.gov/IAWeb/warning.do
https://www.caqh.org/solutions/caqh-proview-providers-0
https://www.mmis.georgia.gov/portal/PubAccess.Home/tabId/2/Default.aspx
Medical Billing
Medical billing is not a “one size fits all” solution especially in the FHC world. Finding the right partner who understands your practice, specialty, and billing needs can be difficult. GPCA staff work with FQHCs to optimize their reimbursement. Furthermore, GPCA staff trains front office and clinical staff to reduce rejections and denials as well as ensure claims process for faster reimbursement.
