MED ADVANTAGE SERVICES

ELECTRONIC HEALTHCARE CREDENTIALING SERVICES

Med Advantage provides online services to Managed Care Organizations who can register online and search our database of over 900,000 medical providers (MD’s & DO’s).

Med Advantage’s online medical credentialing service contains the following information for verifications which is updated every 90 days. The information meets all requirements for The Joint Commission, NCQA and URAC and is compiled from the American Medical Association (AMA), The American Board of Medical Specialties (ABMS), The National Technical Information Service (NTIS), the Department of Health and Human Services (DHHS), and the respective state licensing boards.

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  • Graduation From Medical School
    Primary source verification from the medical school.

  • Graduation From Internships, Residencies and Fellowships
    Primary source verification from post graduate education.

  • Board Certification
    Primary source verification from The American Board of Medical Specialties.

  • Valid DEA Certificate
    Primary source verification from the DEA records certification.

  • Department of Health and Human Services
    Medicare/Medicaid Status
    Primary source verification from DHHS Cumulative Sanction Report.

  • Current Valid License
    Primary source verification of current license and sanction from the state licensing board.

PRIMARY SOURCE VERIFICATION (PSV) 

Medical credentialing is the verification through primary source data of a variety of healthcare provider information including, but not limited to, the following items:

WHAT TO PRIMARY SOURCE VERIFY?

medical credentialing

APPLICATION MANAGEMENT 

NETWORK DATA SERVICES

Med Advantage, along with its data partner, delivers a proven, powerful software solution designed to ensure the accuracy of healthcare and insurance payers’ provider databases and maintain the information on an on-going basis.

Services are performed through a secure, hosted web service (ASP) that scrubs payers’ internal provider file data to identify inaccurate and incomplete information. We can enhance your files with information from our comprehensive database of provider data, which includes primary source-verified data of office-based physicians, practitioners, hospitals and facilities, business entities, pharmacists, pharmacies, ancillary providers, and organizations.

Data services reliably matches and joins data from different sources. Providers are tracked across time, including changes in address, name, license status and affiliations. In addition, this service is actionable and it calculates match scores for automatically interpreting and implementing results based on client-specific rules.

PROVIDER ENROLLMENT SERVICES (PES) 

THE PROBLEM:

The average healthcare provider contracts with anywhere from five to 30 payors, and the appropriate applications or forms need to be requested, credentialing information needs to be gathered, the applications–which can stretch as long as 50 or more pages–need to be filled out by hand, the signed paperwork needs to be submitted, followed up on, then continually kept up with in terms of updating and re-­attesting.

THE SOLUTION:

Med Advantage Provider Enrollment Services is the answer. Quickly and easily submit your medical credentialing documentation to Med Advantage only once, and we’ll keep it on file to enroll you in the networks of your choosing.

Acting as an advocate and liaison between your providers and the payors you have chosen, our experts will see the process through from the application request until you or the provider(s) in your office are participating in a network and receiving reimbursements.

Our Provider Enrollment Services are designed to be an affordable credentialing outsourcing solution to meet the needs of individual providers, as well as larger facilities. If your practice consists of one provider or hundreds, you’re a start-up clinic or you’ve been in business for years, our service plans are tailor-­made to fit your unique needs.

SIMPLIFIED SERVICES (PES) 

  • New-Hire Provider Enrollment

  • Provider Document Maintenance

  • Credentialing/Re-Credentialing

  • NPI/CAQH Registration/Monitoring

  • Hospital Privileges (Appointment/Re-Appointment)

  • Medicare/Medicaid (Initial/Re-Validation)

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