Credentialing

At Fifth avenue, we manage IPA’s for the purpose of improving health plan enrollment. Clients who join will benefit from the following as it relates to the health plans who have “delegated” to the IPA.

  • Effective Dates within 30 to 60 days (Go here for more information)
  • Single application
  • No re-credentialing for 2 years
  • Unified re-credentialing date

For all other credentialing needs:

Our clients will have access to all credentialing information through our proprietary on-line portal. Which includes documents and data stored in a manner that can be downloaded or used to populate common applications such as uniform credentialing applications. This data is extremely valuable to our clients because we update and verify its accuracy every two years, from the source. So, it can drastically improve your chances of a complete and accurate application.

You will also have access to our knowledgeable staff in regards to other credentialing needs such as Medicare/Medicaid enrollment, re-enrollments, practice changes, etc. as well as questions regarding non-delegated health plan applications.

If you are a Hospital, Surgery Center, or other healthcare facility in need of credentialing verification services for your facility, please click here.

Our IPA clients will have access to all credentialing information through our proprietary on-line data portal. Which includes documents and data stored in a manner that can be downloaded or used to populate common applications such as uniform credentialing applications. This data is extremely valuable to our clients because we update and verify its accuracy every two years, from the source. So, it can drastically improve your chances of a complete and accurate application.

You will also have access to our knowledgeable staff in regards to populating facility applications and how to track, follow up, and re-credential with the facilities.

Our proprietary Web-based credentialing data portal provides an interactive tool to communicate with our office and give you control over your credentialing data.

Paperless Document Library – All credentialing documents are scanned in by our intake coordinators and are available for the provider or practice manager to view, print, save or email to other sources.

Multiple User Interface – Setup multiple users and give them access to the information they need and restrict them from the information they should not have access to. Set users up by location, group, tax ID, or even by provider.

Notification Tools – Set certain data elements to notify users of important events like notifying the billing office of a new effective date for specific plans or changes to a provider’s participation level.

Access – All information in the system can be exported to excel for reporting. There are also pre-formatted reports that can be run from within the system such as CME Reports, Provider/Plan Matrix, etc.

Timeline Tracking – Providers are tracked through the credentialing process by milestones to get a detailed picture of the number of days to process, greatly improving expectations and ability to determine problem areas.

About Fifth Avenue’s Plan Enrollment Services

Fifth Avenue is a plan enrollment solution that allows a provider or group practice to outsource the credentialing task through participation in an IPA.  Membership also gives the provider and/or practice access to the enrollment data so it can be used for other credentialing needs such as Non-Delegated Health Plans, Medicare/Medicaid, and Facility applications such as Hospitals and Surgery Centers.

Membership in the IPA gives providers and groups access to much faster and more streamlined effective dates with national payers such as Blue Cross, United, and Aetna as well as local payers..  Fifth Avenue plan enrollment clients include individual health care providers, physician groups, and hospital-based groups. The core aspect of the service is working with physicians, surgeons, physician assistants and nurse practitioners to complete the on boarding of the providers with the health plans participating with the IPA.

Log into Fifth Avenue Client Portal