CLIENT NAME: Anka Behavioral Health, California

Size of Practice:

  • 100 Providers (Provider Types: MD, PHD, NP, LSW)
  • 70 Programs/Locations
  • The Problem:

    Client was losing revenue, because majority of their facilities are billed through county, instead of direct Enrollment/Contracting with Governmental and Commercial payors.

    • The client was interested in generating additional revenue, by getting some of their facilities and providers Enrolled with several payors. 
    • Client was receiving a very low reimbursement for services rendered.
    • Client wanted to enroll all 70 programs into Medicare.
    • Client did try to complete the Medicare and commercial provider enrollment in-house. 

    The Solution:

    • STAT Medcare had an introductory conference call
    • We gathered all of the necessary documents on practice and providers
    • Provider profiles were built in our credentialing system, STATCred
    • STAT Medcare initiated the enrollment with several government and commercial payors
    • Weekly conference calls were scheduled with the client to discuss progress
    • CAQH completed for all providers
    • Client is now able to bill the Governmental and Commercial payors directly, in which the practice has seen an increase in revenue
    • Client has seen a 50% increase in Revenue
    CLIENT NAME: North Hills Surgery Center, Fayetteville, AR

    Size of Practice:

    • 90 Providers (Provider Types: MD, NP, PA)
    • One location

    The Problem:

    This Client has been with STAT MedCare for many years and we completed the initial appointments of all their providers and they were going to manage the reappointments in-house.  However, the Client didn’t have a system in order to monitor and track their provider’s appointment dates or their expirable data and therefore, they hired STAT to monitor and maintain their appointment dates, as well as all expirables. 

    The Solution:

    • As STAT Medcare starts initial appointments, provider profiles are built in our credentialing system, STATCred and appointment dates are tracked and monitored.
    • STATCred sends an automated notification via email to the Lead Medical Staff Coordinator of any upcoming expiration dates and/or reappointment dates at 90/60 and 30 days. 
    • STAT then completes all reappointments and updates the system with the provider’s new reappointment date(s)
    • STATCred also monitors the provider’s expirable data at 90/60/30 and sends an automated notification via email to the Lead Medical Staff Coordinator on all data that is expiring. The Coordinator provides the client with a detailed report and as items are renewed, they are forwarded to STAT, expiration dates updated and documents loaded into our system, STATCred for continued monitoring.
    CLIENT NAME: DR. SIMON

    Size of Practice:

    • Solo Provider, board certified anesthesiologist and addiction medicine specialist
    • One location

    The Problem:

    • Dr. Simon wanted to be enrolled with BCBS and United Healthcare.  However, the American Board of Addition Medicine is not a member board of the American Board of Medical Specialties (ABMS). The process to bring Addiction Medicine into the ABMS as a multi-specialty subspecialty, through sponsorship by the American Board of Preventive Medicine, began February, 2015. However, because of this, most of the plans do not recognize this as a board certified specialty and therefore, the plans wanted Dr. Simon to be credentialed in their behavior health program, but Dr. Simon (and the specialty itself) insists it is a medical specialty. 

    The Solution:

    • STAT was successful in getting the provider contracted with the BCBS and United Healthcare as a mutli-specialty specialist in medicine per the client’s wishes. 
    • BCBS was the first plan to finally agree and this was accomplished due to the experienced and knowledgeable staff at STAT MedCare which included many phone calls, research of the specialty and the board, as well as BCBS rules and not taking no for an answer.
    • Once BCBS approved this provider as a mutli-specialty specialist in medicine and issued him a contract, the staff at STAT MedCare contacted United Healthcare, provided them with evidence of BCBS issuing this type of contract and quickly followed suit and issued this provider a contract.