Best Credentialing Companies for Skilled Nursing Facilities (SNFs) 

The environment of Skilled Nursing Facilities (SNFs) is very regulated and highly risky. To SNF administrators, financial leaders, and compliance officers, the intercultural web of Medicare, Medicaid, and payer enrolment is critical. Failure or error in credentialing would result in lost revenue, noncompliance, or even failure to bill essential services. That is why your SNF should not select just any credentialing company; rather, it is a tactical necessity. 

Why Credentialing Matters for SNFs 

In addition to resident applications, SNFs must also apply to payers (commercial insurance, Medicare Advantage, managed care, and so forth) to be able to charge them for the services they offer. Credentialing agencies will be able to assist SNFs with the application to the payers, the maintenance of CAQH, or other provider directories, and managing payer panels, to ensure that the facility can be reimbursed without additional delays. 

In contrast to the individual provider credentialing, SNFs are subject to facility-level credentialing risks: not only checking the credentials of an individual clinician, but also the license of the facility, the credentials of the directors, the insurance (liability, workers’ compensation, and others), etc. Any mistake or oversight in one of these may put at risk contracts, reimbursement, or regulatory status. This risk is overcome through outsourcing to a credentialing specialist. 

Key Credentialing Requirements for Skilled Nursing Facilities 

So what must a SNF credential- not only its providers but its own facility as well? Here are the core elements: 

Facility License Check: The State license of the SNF should be checked and maintained. 

Medicare / Medicaid Certification Documentation – Documentation of appropriate certificates, CCNs (CMS Certification Number), and revalidation. As an example, on the CMS SNF enrollment data, the SNFs are identified by a CCN and PECOS Associate Control (PAC) ID.  

Insurance: all the liability insurances, worker compensation, and other mandated policies at the facility must be recorded and confirmed. 

Primary Source Verification of Leadership: Credentials (medical director, license, experience) of the medical director, administrator, and the most important leadership in clinical should be checked by primary sources. 

Disclosure of ownership/management:  

According to the recent CMS regulation, SNFs need to make a detailed disclosure of ownership structure and related additional disclosable parties (ADPs).  

W 9 / IRS Documentation: To bill and tax: 

Re-credentialing / Continual Monitoring: periodic recredentialing of Medicare, license renewal monitoring, and continual credentialing. 

Credentialing Services SNFs Need 

To accommodate the above requirements, SNFs usually enjoy the following services in liaising with a credentialing company: 

• Initial Facility Enrollment: The establishment of the SNF in PECOS (or any other applicable system), CMS-855A / other enrollment forms. 

• Provider Enrollment: In the case of the clinicians (nurses, physicians, therapists) employed by the SNF, it is vital to ensure that they have been credentialed on an individual basis regarding payers. 

• CAQH or Equivalent Directory Management: Ensuring the profiles of providers are current to ensure that SNF clinicians are seen and network compatible. 

• Primary Source Verification (PSV): Checking credentials issued by the issuing institutions. 

• Facility Licensing / Insurance Check 

• -Up: Ensuring that all documentation on the facility level is legal and up to date. 

• Payer Panel Enrollment: Obtaining the facility and its providers enrolled in Medicare, Medicaid, managed care, and commercial payer plans. 

• Continuous Monitoring and Recredentialing: Monitoring expiration dates of licenses, revalidation dates, and owned information. 

Top Credentialing Companies for Skilled Nursing Facilities (SNFs) 

Credex Healthcare 

Description: Credex Healthcare is a full-service provider and facility credentialing and enrollment partner. They offer services such as Medicare / Medicaid enrollment, CAQH and PECOS installation and maintenance, primary source verification, and subsequent re-credentialing, and hence suit well the SNFs that will require both facility-level and physician-level credentialing.  

Medical Credentialing Services/ HMS

Description: HMS provides medical credentialing, which expressly covers post-acute care and long-term care providers, such as SNFs. They maintain Medicare, Medicaid, and commercial payer enrollments to keep the facilities up-to-date and in compliance and network-prepared.  

MedTrainer 

Description: MedTrainer is an integration of third-party credentialing services and complete software solutions for credentialing. They can handle primary source verification all the way up to enrolling payers, recredentialing, and exclusion tracking that require a strong and clear credentialing partner. 

LTC Consulting Services (LTC CS)

Description: LTC Consulting Services is a provider of services such as SNFs, which assisted them in the enrollment of providers, the certification and approval under Medicare / Medicaid, as well as the structuring of their ownership. LTCCS 

NGA Healthcare 

Description: NGA Healthcare offers credentialing to both healthcare providers and healthcare facilities. The portal enables them to monitor recredentialing, expiries of licenses, Medicare revalidation, and payer enrollment in real time, which is quite helpful to SNFs. 

SHCMCS strategic health care managed care solutions

Description: SHCMCS provides credentialing services to various situations such as long-term care, skilled nursing, assisted living, and hospice. They deal with payor credentialing of the government, hospital privileges, CAQH, and enrollment in Medicaid.  

 Credentialing Network (TCN)

Description: TCN has provider and facility credentialing as well as revenue cycle. Among their clients, they specifically mention facilities (such as long-term care), which assist SNFs in paying enrollment and credential monitoring. 

Legacy Consulting Services 

Description: Legacy Consulting is a proactive credentialing assistant, CAQH management assistant, recredentialing assistant, and payer applications assistant. The experience of their team also assists the facilities (and providers) in keeping files clean and updated. 

ProviDRs Care 

Description: ProviDRs Care assists network credentialing of SNFs, as well as long-term care facilities. They have their credentialing requirements that allude to NCQA and CMS standards, which make them a plausible CVO-compatible vendor to nursing homes. 

The Compliance Team (TCT) 

TCT offers accreditation and certification, along with support in compliance. This is an experience-based, reputation-based company, although not a pure-play credentialing company with CMS regulation, they have experience and reputation that can make it a worthwhile collaboration with long-term care facilities with high-fakes compliance and quality.  

Benefits of Outsourcing Credentialing for SNFs 

• Less Administrative Oversight: SNFs frequently do not have internal units that have the capacity or know-how to store intricate Medicare / Medicaid credentialing. Outsourcing liberates the internal personnel. 

• Accelerated Enrollment/Revalidation: Expertise experts are aware of streamlining the applications, following up with the regulators or payers, and minimizing the turnaround times. 

• Increased Compliance Better Credentialing firms remain abreast of regulatory changes (such as CMS revalidation rules) and lessen the likelihood of non-compliance. 

• Reduced Denial Risk: SNFs have reduced chances of denial of an application because of the failure to submit documentation or disclose ownership errors with the assistance of an experienced credentialing company. 

• Ongoing Surveillance: Credentialing is not a set-and-forget task. An effective partner keeps track of license expiries, recredentialing deadlines, and payer revalidations to ensure you do not stumble. 

How to Choose the Right Credentialing Partner for a Skilled Nursing Facility 

When evaluating partners, SNFs should consider: 

• Long-term care experience: Ensure that the company has been dealing with facility-level enrollments, Medicare CCNs, and long-term care revalidation. 

• Knowledge in Regulations: With recent changes in CMS, a partner must have exceptionally good knowledge of the ownership disclosure regulations and revalidation processes. 

• Technology and tracking: Select a company that provides dashboards, automatic reminders, and status updates in real-time. 

• Transparency & Reporting: You must be able to easily view the status of applications, insignificant delays, and items pending. 

• Account Management: There is a specific account manager or a team to maintain continuity and accountability. 

Why Credex Healthcare Is an Ideal Partner for SNF Credentialing 

Credex Healthcare is in a good position to expand to serve skilled nursing facilities due to the expertise and scalable infrastructure, and compliance-first nature. Here’s how: 

• Specialized Facility Credentialing Unit: Credex possesses specialists who comprehend the special requirements of SNFs, license verification, Medicare CCN enrollment, ownership disclosure, and revalidation. 

• Complexity of regulations: As the CMS regulations evolve regarding ownership and revalidation, Credex keeps up to date and can take the lead and direct SNFs through the process. 

• Strong Technology: The credentialing dashboard used by Credex enables facility heads to monitor the status, place the necessary documents, and receive reminders on the revalidation timeline. 

• Constant Supervision: Credex does not enroll and leave. They offer continuous tracking of license expiries, insurance renewals, and updates of credentials. 

• Clear Communication: Clients will receive clear reporting, regular status reports, and a dedicated account manager to facilitate proper execution. 

• Cost-Effectiveness: As a large-scale company, it is likely that Credex will be able to provide competitive pricing, which will lessen the pressure of operations on SNFs. 

Frequently Asked Questions (FAQs) 

Q: What is the timeframe of SNF credentialing? 

A: The timeline varies. PECOS and CMS-855A may require 60-120 days or more to enroll initially in Medicare, based on the documentation accuracy, structure of ownership, or state processing time. 

Q How about the Medicare certification and CCN of the SNF? 

A: Yes- Credex can assist SNFs with checking the CMS Certification Number(CCN) and correcting their PECOS profiles, as well as submitting the necessary CMS-855A forms. 

Q: What payers can get credentialed on SNFs? 

A: Credex can serve Medicare (Part A), Medicaid, Medicare Advantage, managed care organizations, and private payers based on the business model of the facility. 

Q: In what way do you re-credentialize / revalidate? 

A: Credex monitors the expiration dates of licenses, changes in the ownership structure, and deadlines of CMS revalidation. On behalf of the SNF, they make reminders and file revalidation applications. 

Q: What occurs in the case of the ownership change of my SNF? 

A: Credex will be able to process ownership disclosure reports, such as additional disclosable parties, which can be used to ensure the artwork of CMS ownership requirements is increased. 

Q: Do you assist with payer audit/denials in respect to credentialing? 

A: Yes. Credex provides services related to post-enrollment, such as payer follow-up, resubmission of documentation, and resolving denied credential-based ones. 

Conclusion 

Credentialing is not an administrative task to perform by skilled nursing facilities: it is a mission-critical process, as it provides the facilities with regulatory compliance, the ability to secure payer contracts, and financial sustainability. Medicare revalidation, ownership disclosures, and licensing of facilities, as well as the enrollment of payers, make it critical to ensure that SNFs engage a credentialing company that actually comprehends long-term care. 

Credex Healthcare is one of the best options due to professional staff, powerful technology, certification, and long-term devotion to observation. When you outsource your SNF-credentialing to a partner, such as Credex, it is an act of reducing risk and saving time, and you are also fully in compliance and in a better position to offer the quality care that your residents require.