Transforming Credentialing and Contracting for Multi-State Dermatology Practice

Executive Summary

Thomas Dermatology, a respected dermatology group with multiple locations across Nevada and Arizona, partnered with Tribunus Health to enhance their credentialing and contracting processes. Recognizing the need to optimize revenue streams and streamline administrative tasks, Thomas Dermatology sought a strategic partnership to support their continued growth and focus on delivering exceptional patient care. Together, Tribunus Health and Thomas Dermatology were able to improve efficiencies, allowing the practice to focus on clinical excellence and expansion.

Background

Thomas Dermatology is a leading general, surgical, and cosmetic dermatology practice known for providing high-quality, accessible care through an extensive specialty provider panel, and strong leadership. This case study demonstrates how Tribunus Health collaborates with specialty practices to create substantial value through expert credentialing and contracting services, regardless of practice size or complexity. By combining data analysis, payer relationship management, and administrative excellence, Tribunus Health supports Thomas Dermatology in maximizing their revenue potential and operational efficiency.

Challenges

Thomas Dermatology recognized the following challenges as opportunities for improvement:

• Contract Optimization: The practice aimed to optimize its existing contracts, transitioning to agreements that better reflected the value and scope of their services.
• Credentialing Efficiencies: Thomas Dermatology sought to enhance the efficiency and accuracy of its credentialing and enrollment processes to ensure seamless network participation for its providers along with compensation for all associated services.
• Market Position Awareness: Gaining deeper insights into their competitive advantages and value proposition was a key goal for Thomas Dermatology to strengthen their negotiation position.
• Managing Growth: As the practice expanded, Thomas Dermatology proactively sought solutions to manage the increasing administrative demands of maintaining accurate credentialing and contracting.

Our Approach

Tribunus Health and Thomas Dermatology worked together to implement a comprehensive and collaborative strategy:

1. Collaborative Assessment: A joint effort was undertaken to evaluate existing contracts and credentialing status, identifying areas for improvement and alignment with the practice’s goals.
2. Transparent Communication: Progress is communicated through regular meetings, detailed reports, and a user-friendly dashboard system providing real-time access to status updates.
3. Strategic Contract Prioritization: A prioritized approach to contract renegotiation was developed, focusing on agreements with the greatest potential for revenue impact and strategic alignment.
4. Enrollment Partnership: What started as basic enrollment support expanded into services for the entire practice, including commercial payer enrollment, applications and revalidations, CAQH maintenance, and credentials verification.
5. Value Proposition Enhancement: Claims data was analyzed to highlight Thomas Dermatology’s strengths, particularly their superior outcomes in Mohs procedures, to be leveraged in negotiation strategies.
6. Continuous Improvement: Workflows and handoff procedures were continuously refined to accommodate the practice’s growth and increasing provider count, ensuring efficient integration of new providers.

Successes

Significant Revenue Increase: Strategic contract negotiations have generated over $3 million in additional 3-year revenue for Thomas Dermatology.

Seamless Network Participation: Thomas Dermatology now rarely experiences claims denials due to provider network status issues.

Growth Support: Successful management of credentialing and contracting has supported practice expansion from 6 to 7 locations and from 27 to 35 providers within two years.

Multi-Year Contracts: Favorable multi-year agreements with key payers have been secured, creating predictable revenue streams and reducing administrative burden.

Trusted Partner Status: Tribunus Health has become a trusted extension of Thomas Dermatology, serving as their complete credentialing and contracting department.

Referral Source: The strength of the results has led Thomas Dermatology to actively refer other practices and serve as a reference for prospective clients

Conclusion

Over a two-year engagement, Tribunus Health and Thomas Dermatology have forged a strong partnership that has transformed their credentialing and contracting operations, resulting in over $3 million in additional revenue. By negotiating numerous contracts and implementing comprehensive credentialing management across their growing practice, Tribunus Health has enabled Thomas Dermatology to focus on delivering exceptional patient care while managing the administrative complexities of provider enrollment and payer relationships.