Credentialing and Administration

Credentialing And Administration

Credentialing Services

Credentialing is the process administered by groups, typically insurance plans or hospitals, that ensures patients receive excellent, safe care. Those who meet these criteria each group has developed are felt to possess the qualifications necessary for providing quality, medically necessary and appropriate care. This process also requires that the provider agrees to adhere to the quality standards set by these groups.

Credentialing applications and maneuvering the process can be laborious without the proper experience. Laboratory credentialing is especially tedious and disappointing due to the fact that commercial plans as well as a few Medicare Advantage and Medicaid NC Medicaid Managed Care Tailored Plans have closed panels.We maintain a list of contacts and a list of closed panels in order to provide superior service. CMLM recognizes that these contacts and rules constantly change so we continually update our information.
Coding Services

Coding Services

CMLM has extensive experience in working with CPT and ICD-10 codes and can provide advise on the selection of these codes. No one but the provider knows the services performed but maybe there is a question as to which code should be used. Molecular diagnostic coding is particularly complicated.

Administrative Services

Sometimes it is helpful for an experienced third party, like CMLM, to review your processes and workflow. We all have a tendency to want to do things as we always have instead of reevaluating for a better outcome.

Billing Services

Billing involves eight simplified steps:
  • 1.Coding your work.
  • 2.Entering CPT codes, modifiers, and ICD-10 codes into a software system.
  • 3.Transmitting this information to a clearinghouse.
  • 4.Parsing and transmitting scrubbed data to the payor.
  • 5.Payor determination and creation of a digital Explanation of Benefits and payment.
  • 6.Reception of the digital EOB by the clearinghouse.
  • 7.Review of the EOB by your billing agent.
  • 8.Working the denials.
CMLM is not a billing company but can assist with steps 1 and 2. We have reviewed the national options for laboratory billing as well as a couple of high quality regional billers. Medical practice billing is best performed with your EHR partners in mind.

Website Development

CMLM partners with premier design and development companies across the globe. We can create any logo or website you can dream. Let us make a digital home of which you can be proud visually and one that functions great from a technical standpoint.