1. Payer Individual & Group Contract Research, Procurement & Rate Negotiation – $200 per hour
exydoc provides specialized consultancy to assist Customer with payer relationship management and contract optimization. Services include, but are not limited to:
- Contractual & Financial Audit: Reviewing existing payer fee schedules, reimbursement terms, and evergreen clauses.
- Market Analysis: Preparing comparative rate benchmarking and data-driven negotiation strategies.
- Proposal Management: Drafting and submitting formal rate amendment requests or “Letters of Intent” to payers on the Client’s behalf.
- Liaison Services: Facilitating professional communication and follow-up between the Client and payer representatives to streamline the negotiation lifecycle.
Client agrees to provide necessary historical billing data and current fee schedules required for accurate analysis. exydoc provides business and financial strategy; services do not constitute legal advice. Client is encouraged to have final contracts reviewed by legal counsel. exydoc does not guarantee specific rate increases or contract acceptance.
2. CAQH Initial Set-up/CAQH Rescue: $375 per provider (One-time)
exydoc provides comprehensive CAQH profile management to ensure a provider’s “ProView” status is active, accurate, and visible to payers. This one-time fee covers either New Profile Creation or Profile Rescue & Restoration, defined as follows:
A. New Profile Creation (Initial Setup)
For providers without an existing CAQH presence, exydoc will:
- Register & Initialize: Secure a CAQH Provider ID and establish account credentials.
- Comprehensive Data Entry: Input all required professional data, including demographics, education, training, specialties, and work history.
- Document Integration: Upload and categorize all mandatory primary source documents (State Licenses, DEA, Board Certifications, and Malpractice COIs).
- Initial Attestation: Complete the first formal attestation to move the profile to “Initial Review” or “Active” status.
B. Profile Rescue & Restoration (Expired or Outdated Accounts)
For providers with existing accounts that have lapsed, been locked, or contain outdated information, exydoc will:
- Account Recovery: Assist the provider in regaining access to locked or inaccessible accounts.
- Discrepancy Audit: Perform a top-to-bottom audit to identify expired documents, missing work history gaps, or outdated addresses that may be stalling credentialing.
- Data Remediation: Update all stale data points and replace expired credentials with current documentation.
- Compliance Restoration: Resolve any “Incomplete” or “Re-attestation Required” flags to return the profile to a compliant, “Active” status visible to contracted payers.
3. Special Projects & Credentialing Debt – $85 per hour
For tasks falling outside the standard scope of defined services, or for the resolution of “Credentialing Debt” resulting from prior mismanagement, exydoc applies a Special Projects hourly rate. This ensures dedicated resources are allocated to correcting historical inaccuracies and administrative backlogs.
A. Credentialing Debt Remediation
This includes the “cleanup” of legacy issues caused by previous administrative gaps, mismanagement and/or third-party errors, such as:
- Historical Data Correction: Researching and resolving conflicting provider data across various state and federal databases (NPI/NPPES, PECOS, State Boards).
- Gap Reconciliation: Investigating and documenting unexplained gaps in work history or malpractice coverage required for current applications.
- Legacy Claim Resolution: Assisting with administrative paperwork to resolve “denied-due-to-credentialing” claims from prior service periods.
- Directory Audit & Cleanup: Correcting inaccurate “find-a-doctor” directory listings and outdated practice locations across multiple payer platforms.
B. General Special Projects
Services requested by the Customer that are not specifically outlined in the primary Service Agreement, including (but not limited to):
- Custom Reporting: Developing specialized internal tracking spreadsheets or credentialing status reports beyond standard updates.
- Mass Site/Location Adds: High-volume administrative entry for large-scale practice expansions or acquisitions.
- Payer Portal Setup: Initial creation and user-management setup for various third-party payer web portals.
- Document Digitization: Converting physical provider files into organized, audit-ready digital repositories.