Insurance Contracting and Credentialing

The Vendor is required to provide to support rural departments in the provision of health insurance contracting and credentialing services for clinicians and programs.
- This initiative will strengthen rural agencies’ capacity for Contracting and credentialing with insurance providers.
- By improving empanelment and billing processes, rural residents will gain increased access to covered services locally, supporting earlier disease detection, improved chronic disease management, and reduced reliance on high-cost acute care.
- Departments are essential community providers, serving predominantly low-income, medically underserved individuals.
- Payer relations and application processes
- Facilitate contracting, enrollment and credentialing of department clinicians with public and private insurance payers, clinicians may include but are not limited to RNs, PTs, OTs, COTAs, PTAs;
- Ensure timely, compliant, and complete contracting and credentialing processes;
- Promote long-term financial sustainability of rural public health services through increased capacity to provide clinical services by contracting with additional insurance providers that serve patients in the service area
- Explore the potential of aggregating rural LHD clinicians in contracting/provider enrollment so as to be able to benefit from aggregating impact of panels/ economies of scale in insurer contracts and credentialing
- Resolution of deficiencies, rejections, or requests for additional information from contracted insurance providers
- Support for revalidation, re-contracting, re-credentialing, and updates as needed
- Ongoing documentation and reporting of contracting and credentialing status
- Preparation, submission, tracking, and follow up of contracting and credentialing applications to final determination.