Third‑Party Contracting Assistance

Outcomes

· Faster credentialing and fewer coverage gaps
· Improved reimbursement profile

Typical deliverables

· PBM/PSAO strategy
· Enrollment submissions
· Fee/term analysis
· Re‑credentialing reminders

FAQs

What’s the difference between PSAO vs. direct contracts?

PSAOs aggregate PBM relationships and manage credentialing/administration; direct offers more control but more workload.

Which identifiers matter for payer setup?

NPI, NCPDP Provider ID, TAX ID, state licenses, DEA (if applicable), accurate NCPDP Online profile.

What terms warrant close review?

Reimbursement methodology, audit/recoupment provisions, MAC appeal process, GER/BER, payment timing, arbitration/venue.

How to prep for re‑credentialing?

Maintain a current credentialing file; calendar expirations; review amendments before signing.

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