I’m already a provider, do I need to re-credential when moving/adding a new location?

When you move or add a location you have to notify insurer of new location. You will need to complete an ‘Add location’ form or possibly, depending on carrier requirements, complete new credentialing paperwork.

Why would an insurance company want to negotiate and pay me more, “they don’t need me”? 

A carrier is only as strong as its network, and if they feel that your office is important to their network, they will look to encourage you to maintain membership.

Why does credentialing take so long?

The insurance companies receive requests all day long and they follow protocol which often takes from 60-90 days until it is turned around and implemented.

Does negotiating and increasing my reimbursement rates hurt my “relationship” with the insurances company?

No.

Will I appear lower on their websites so as to direct new patients to the offices they pay less? 

No.

How will we know if we are really being paid more?

We offer a monthly reporting model in which we review your EOB data on a monthly basis and will generate a report illustrating utilized codes.

How long does credentialing take? 

60 – 90 days

How long does negotiations take? 

90 to 120 days

Can you negotiate for us before credentialing? How long does that take? 

Some carriers will allow us to have that conversation. It could add up to 2 months to the credentialing process.

What’s the benefit of having Apex negotiate for us rather than attempting it ourselves?

Apex has developed strong relationships with insurance carriers, we are engaged in this process on a daily basis thereby utilizing our experience and knowledge, and saving you time!

How much of an increase can we expect? 

Average range of increase is 8%-12%. We have experience increases that have been both less and more than this range.

How long do I have to pay you?

Each of our client contracts are customized to fit the needs of the practice landscape. Please refer to the terms of your agreement.

How does Apex get paid?

Apex tailors each contract to fit with the client’s need. However the common theme among each contract is that they have a pay-for-performance clause. Only when Apex is successful, do we charge a fee.

I have heard about your monthly reporting model. How does that work?

The monthly reporting model works as follows. We are paid based on utilization. We obtain this data from the EOB’s or upon receipt of your office utilization report. We review and tally up the utilization and generate a report, each month, that will clearly identify where your utilization is within each carrier, as well as, indicate how much revenue you are generating monthly with that carrier(s).