We work with many clients in Texas and would be happy to assist you with any practice management, physician credentialing / insurance enrollment, or practice start-up needs.  We provide a variety of services to fit your needs and custom design each proposal to make sure you only pay for what you need.

Here is the process we follow for our new start-ups that need credentialing and start-up assistance.

1. Work to ensure that the client is properly credentialed with all necessary commercial, workers compensation, and government payers (as many as needed) based on the client’s practice location.  Physician Practice Specialists (PPS) will ensure that the NPI number for the individual and group are set up correctly so that the Medicare crosswalk can perform correctly.

2. PPS will establish the newly formed group with all applicable payers including Medicare & Medicaid.

3. We will deliver to client the necessary ERA/EFT applications to assist in setting up electronic billing.

4. PPS will negotiate commercial and workers compensation contracts in order to achieve the highest possible reimbursements for the client’s services.  We will weigh every contract according to the most frequent CPT codes and current local Medicare rates.

5. PPS will assist in obtaining and setting up the client’s Group NPI number and individual CAQH provider number.

6. We can and will assist to the best of our ability with the completion of all applications and requests for information.  Client is responsible for signing all applications and verifying the information as completed by PPS.

7. PPS will assign the client an account manager who will track the progress of all applications, fee schedules, and contracts to ensure a fast and efficient enrollment process.

8. We will provide weekly or bi-weekly updates on the status of all activities and be available for any questions or concerns.

9. PPS will at all times strive to perform our duties to the satisfaction of our client and will maintain the highest standards of character and business ethics.

10. For hospital credentialing, we will charge two hundred and fifty dollars ($250) per physician per hospital.  Hospital credentialing fees are billed upon the successful completion of the necessary hospital applications.

11. PPS will set up LLC, PA, or Corporation and obtain the client’s EIN for an additional fee of $300.  Client is responsible for any fees associated with forming a new business in the state of Texas.

12. PPS can obtain a certificate of exemption (Clia Waiver) for the client at a fee of $250.

13. We will maintain the credentialing status of the practice for the first six months at no additional cost.

14. PPS can provide billing and management services for an additional monthly fee.  Common services include a monthly productivity analysis, AR reporting and management, claim denial oversight, compliance management of staff, contract negotiations for vendors, recruitment services for physicians or mid level practitioners, employee handbook, and financial services using our CPA.  *Price can vary (higher or lower) depending on the group size and services needed.

15. Our company can also provide payroll management, accounting, and business development services for additional fees.

Here are some of the insurers that we work with in the Texas market.  There are many insurance companies that might be worth participating with depending on your location.  We also work with numerous workers compensation networks that may be beneficial to your practice.

  • Aetna
  • BeechStreet-MultiPlan-PHCS
  • Blue Cross Blue Shield of Texas
  • Bravo Health Texas
  • Care Improvement Plus
  • Cigna
  • Celtic Insurance Company
  • Coventry/Advantra/First Health
  • Evercare of Texas
  • Fortified Provider Network
  • Galaxy Health Network
  • Golden Rule Insurance
  • Great West
  • HealthSpring
  • Humana
  • InterPlan
  • John Alden Life Insurance
  • Kelsey Seybold
  • Medicaid
  • Medicare
  • Metlife
  • National Provider Network
  • Plan Care America
  • Prime Health Services
  • Principal Life Insurance Company
  • Select Care/Texan Plus
  • Scott & White Health Plan
  • Superior Healthplan Network
  • Sterling Health Plans
  • Texas True Choice
  • Texas Health Insurance Pool
  • Three Rivers Provider Network
  • Tricare
  • Tricare Humana
  • Tricare United
  • United Mine Workers
  • United Healthcare (UHC)
  • USFHP
  • USA Managed Care Organization
  • Universal Health Plans
  • Wellcare of Texas

We provide services to physicians and facilities across the great state of Texas.  Here are a few cities where we have recently provided credentialing or practice start up services:

Austin
Fort Stockton
Bandera
Odessa
Abilene
Tyler
Fort Worth
South Padre Island
Bastrop
Big Spring
Grapevine
Beaumont
Dalhart
Killeen
Comanche
Kerrville
Galveston
Nacogdoches
Midland
Amarillo
San Antonio