Laboratory Credentialing & Enrollments

Specialization in enrolling Laboratories with all Commercial & Non Commercial Payers, in the fastest TAT

All MAC’s, Medicaid’s, Managed Care plans, PPO/HMO, All Commercial Plans / All 50+ States

Credentialing & Enrollment with the right payers is the key factor that determines every medical laboratories growth and revenue. Your Lab needs to be in network with maximum payers in the key areas where you’re getting your samples from.
Bikham Healthcare has an 18+ years long specialization in credentialing and enrolling medical laboratories in all 50+ states.

Our Credentialing & Enrollments Work Flow Includes:

Network Research

We make sure your Lab has the most varied, popular and effective In network Payer Mix. Our credentialing team runs an extensive network research program for your local state and the states that you would be expecting potential business from. We get you the fee schedules of all commercial and non-commercial payers so you can calculate the exact revenue before taking on new test volumes.

Contract Negotiations

We not only get you the contracts, but we do rate negotiations for you as well. We have an extensive database of all payers’ latest fee schedules. We study your competition and this data helps us to make sure we get you the best possible rates for your procedures, thus solidifying optimum reimbursements for your Lab.

Filing Applications

We send you a sound check list of all the information & documents that we need from you in order to file the applications. Once we have those from you, our credentialing team goes ahead and files the appropriate contract applications and makes sure it’s a flawless submission in the first go, owed to our extensive experience.

Appeals for Closed Panels

Payers like UHC, Aetna, BCBS sometimes have closed panels for Labs for a particular area. We make sure we send extensive appeals outlining the key points of your service, including niche services and how you bring exceptional patient care in your area. We include all this in your business plan and submit to senior provider representatives at that payer. It’s really difficult to overturn closed panel decisions but we have had 50% success rate there.

Regular Follow Up

Our team follows up on the submitted application fortnightly to make sure the submitted appeal has been received and is in the payers system and that no additional information is being requested and everything is smooth. We follow up regularly until the contract comes through and is delivered to your physical location.

Shared Portal

We have an immaculate credentialing portal, which contains live status of all your applications and gives you complete access to all the steps involved in the submission, follow up, re-submissions if any, till the time the contract comes through. We have all the fee schedules available on this portal as well.

OON Enrollments

Bikham provides OON Enrollment services to providers who choose to stay out of network with certain payers or are forced to stay out of network due to any closed panels. Our team helps with out of network Enrollments, NPI registrations on the payer’s website etc. so your Lab is listed in the payers system, to start receiving out of network payments.

Demographic Changes

We help with all basic and complex demographic changes such as updating a new TAX ID with all payers in your payer mix, updating a new address, bank account, adding a new medical director or physician to the Lab. We also help set up all ERA, EFT Enrollments.

Ordering Physician's Enrollment

Our team helps credentialing your referring or ordering physicians from the facilities or clinics that are sending you the tests. It could be single practitioners or physician groups, we can get them added to an existing group contract or get stand alone contracts for them as well.

Provider Database Management

For larger facilities and Labs, provider database management is pivotal. We manage and maintain all your providers and facilities data on our credentialing portal, the comprehensive and transparent HIPAA compliant tool that we specifically designed to make sure we upkeep your databank with utmost efficiency.

PECOS & CAQH Maintenance

Keeping up to date PECOS and CAQH profiles is of utmost necessity in today’s healthcare environment. The biggest payers are all turning the CAQH route to credential providers and Labs. We maintain and upkeep your CAQH and PECOS profiles, making sure all your information is accurately profiled in and compliant.

Do you think you have an Optimum Payer Network?

Check out the most popular payers in your State. Compare with your patient inflow and see which ones you need to be contracted with.

Don't turn your patients away just because you don't have a specific contract.

We can get it for you in the fastest TAT and the best contract rate.

Check out the most popular payers in your state

Network Research and Optimization

We are your development & expansion partners! Here’s how this works. We study and understand your marketing efforts and networks from you and design an expansion and contract procurement strategy accordingly. You constantly give us headways into the direction of which states and locations your marketing management groups and marketing reps are indicating test volumes from.

Our credentialing team goes in and does an extensive network research of those areas and gives you a comprehensive report on how many payer contracts we can get and what would be the turnaround time. We go ahead and get those for your Lab in the time frame promised. This includes aggressive contract rate negotiations as well.

Our team has great connections by now with most provider network managers and provider representatives who are specifically assigned to the task of rate negotiations. These connections make our job easier, of getting better rates for your procedures and tests.

This approach has helped our Lab clients immensely in expansion and procuring new business and successfully getting fast reimbursements on the same. We make sure we get you the maximum contracts so your Lab can have the most varied in network payer mix in your area, and countywide as well, so you can procure good volumes of business from multiple states.