Complaintsfor1st Credentialing

• Initial Complaint

  05/18/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  We contacted this business for their services. We had an agreement that they would start the work at the beginning of a specific month (which they did not, in fact they did not begin the work until 3 months later after the agreed upon time). Once they finally did "begin" they did not send us anytype of timely communication or updates on what (if anything) was being completed. We were told that we would receive Progress Reports every 2 weeks, but that never happened. We only received 1 Progress Report after numerous emails and complaints inquiring about the progress of our work almost 6 months later. We had already done more than half of the work ourselves at this point whilst waiting for them to start. The individual(s) assigned to our case kept changing and/ or were constantly "out of the office" almost each time we attempted to reach out to them to get a status update. Then months later (about 1 year later) they sent us bills for work that was not even done or that we were not even aware of what/ how it was done (again no proof or work or Progress Reports were sent to us along the way as initially promised so we had no way of tracking what was actually completed or incomplete, etc.). It was a disaster. They would occasionally respond to emails and say they were going to get certain things done and then email us once they did, but then would never follow-up and actually send it. It was very frustrating and stressful.Ultimately, the entire process was completely disorganized and no progress was made. They wasted our time and now are demanding money and sending us "collection notices". This is not acceptable. We would like to see proof of work that was actually done in a timely manner. The minimal work that they maybe did do was NOT done in a timely manner as initially agreed and we lost clients because of it. Ultimately this is not the type of service we had agreed to pay for.*They do NOT reply to any of our inquiries regarding their bills/ collection emails.

  

  Business response

  05/24/2023

  *****: We contacted this business for their services. We had an agreement that they would start the work at the beginning of a specific month (which they did not, in fact they did not begin the work until 3 months later after the agreed upon time). 

  RESPONSE:  Client was introduced on 8/17. Intake call happened on 8/22. Projects were loaded on 9/08. CAQH for ********************* was updated on 9/19. The team began initial outreaches on 10/03. We didnt receive CAQH logins for the other providers until 10/27. ************** gave us pushback that she didnt want the providers CAQHs. After *** and I both explaining the necessity, ***** eventually agreed and these were updated on 12/23 (UHC email attached for reference). Initial outreaches were being worked in the interim and so were any applications not being held up by the missing CAQHs.

  *****: Once they finally did "begin" they did not send us anytype of timely communication or updates on what (if anything) was being completed. We were told that we would receive Progress Reports every 2 weeks, but that never happened. We only received 1 Progress Report after numerous emails and complaints inquiring about the progress of our work almost 6 months later.

  RESPONSE: Ive attached the email sent to her on 11/01/2022 with a current project report and instructions for her to add those emails on her end to ensure she received the automated reports going forward. She also received a final report from me in March when the rest of their projects were closed per her request. It does appear that ***** was receiving the automated project notices regarding approvals and missing information because *** was also ccd on those. Ive also attached one of those for reference. Additionally, there are weekly and sometimes daily responses to her email questions from *** from Sept 9th- March. There are at minimum 124 email responses I can see (just on my end) between September & March.

  *****: We had already done more than half of the work ourselves at this point whilst waiting for them to start. The individual(s) assigned to our case kept changing and/ or were constantly "out of the office" almost each time we attempted to reach out to them to get a status update. Then months later (about 1 year later) they sent us bills for work that was not even done or that we were not even aware of what/ how it was done (again no proof or work or Progress Reports were sent to us along the way as initially promised so we had no way of tracking what was actually completed or incomplete, etc.).

  RESPONSE: This is false. They didnt even begin with us until 08/17/2022 and all projects were closed per her request on 03/28/2023 when Accounting forwarded notice that client sent on 02/16/2023 requesting that all services be discontinued.

  *****: It was a disaster. They would occasionally respond to emails and say they were going to get certain things done and then email us once they did, but then would never follow-up and actually send it. It was very frustrating and stressful. Ultimately, the entire process was completely disorganized and no progress was made. They wasted our time and now are demanding money and sending us "collection notices". This is not acceptable. We would like to see proof of work that was actually done in a timely manner. The minimal work that they maybe did do was NOT done in a timely manner as initially agreed and we lost clients because of it. Ultimately this is not the type of service we had agreed to pay for.  *They do NOT reply to any of our inquiries regarding their bills/ collection emails.

  RESPONSE: Overall, this was a difficult client from the beginning. She did not give us enough time from the receipt of all of the information we needed for these enrollments to process and approve. She was originally onboarded by ***** and then given to ***. Her coordinator did not change multiple times. We requested a standing call with her several times (one of which I requested directly, see attached email from January) and she never replied to get them setup. She preferred to call *** directly which occurred MULTIPLE times per WEEK. *** always returned her calls and we spoke several times about her conversations with this client. Additionally, ***** changed the course of what we were working on several times which made it difficult to make progress.

  A few examples are:
  She was adamant she wanted a group agreement for United Healthcare but they required a minimum of 5 providers which she did not have at that time. We advised her our only option was to get them contracted individually and they could approach UHC for a group agreement once they had 5 total. She asked us to then close out UHC ******************* but then came back with additional providers and wouldnt provide CAQH information, so she eventually asked us to close these out again because she would take care of the two she didnt want to provide CAQH information on.

  
  MHN (insurance company): she stated during onboarding that she had already submitted the application to the payor and just needed us to follow up. We discovered that her request was never processed due to missing information. We were able to get everything being requested submitted back over to MHN on 10/28. The client then reached out upset a week later stating we had submitted a blank W-9 to MHN and they had been unable to process the request. This was correspondence she was receiving in response to her original submission that she never shared with us. We explained to her that wed already rectified this with the payor and the request was in process. She continued to send outdated information or did not provide information at all that she was receiving from the payor directly which made it difficult for us to properly track status.
  

  Customer response

  05/25/2023

  Complaint: 20072048

  
  I am rejecting this response because:   It is false and inaacurate (See full response Attached) 
  
  Regards,
  
  *******************;  

   

  

  Business response

  05/29/2023

  ***** was introduced to her team on 8/17. Intake call happened on 8/22. Projects were loaded on 9/08. CAQH for ********************* was updated on 9/19.The team began initial outreaches on 10/03. We didnt receive CAQH logins for the other providers until 10/27. After explaining the importance of CAQH, ***** eventually agreed and these were updated on 12/23 (UHC email attached for reference). Initial outreaches were being worked in the interim and so were any applications not being held up by the missing CAQHs. Her team sent her an email on 11/01/2022 with a current project report and instructions for her to add those emails on her end to ensure she received the automated reports going forward. She also received a final report from me in March when the rest of their projects were closed per her request. It does appear that ***** was receiving the automated project notices regarding approvals  and missing information after November because we have record that they were sent and did not bounce. Additionally, there are weekly and sometimes daily responses to her email questions from *** (Coordinator at 1st Credentialing) from Sept 9th-March (when ***** asked us to stop work). There are at minimum 124 email responses between September & March.

  We did not change her point person but instead she had her original intake call with our Assistant Manager, ***** and then she was handed off to her Coordinator and point person from that time forward. I am not sure where the confusion is on this point, but I am sorry that this was her impression. Credentialing is a long and difficult process which may require additional documents along the way. Unfortunately, we cannot always predict how an enrollment with the insurance companies will go or how long it will ***************** is to assist the client with the process but we do not have control over what is needed or the length of time it takes for the process to complete. 

   

   

  Customer response

  05/30/2023

  Complaint: 20072048
  
  I am rejecting this response because: It is false and inaccurate (as usual) 

  Our issue was that first of all, we were told that our project would begin in late August and as you stated in your last response 1st Credentialing did not start it until October (10/03), so that was the first discrepancy. Thereafter, nothing was regularly communicated to us (aside from random invoices) in terms of what was being worked on and submitted, despite the fact that we requested to be notified each time an application for a panel was submitted, in order to keep track of what was going on. Next, each time we tried to call and reach someone at 1st Credentialing to relay this request no one ever answered the phone. When we attempted to send emails, our initial emails were often ignored or we would receive an automatic email response stating that the individual(s) was/were out of the office. I repeatedly spend a lot of time and effort re-sending our List of Panels we wanted to be credentialed with, and explaining our requests (such as which emails to list and sending us weekly Progress Reports, or responding to certain panels who sent us emails inquiring why we have not completed the application process, etc.) over and over, and they STILL never got done correctly. Also, similar to your previous email about the W9 being incorrect, which contrary to what you had stated in your previous response we were the ones who caught the mistake and again repeatedly tried to bring it to your attention (please see previous screenshot of our W9 email to 1st Credentialing attached as proof), your statement about the **** is also incorrect. The ONLY time you needed the **** information for the other 2 Providers was when ***** reached out to *** in December to inquire about the *********************** panel, which she had NOT even started (until LATE December 2022). She then rushed and demanded all of the information including the **** information for the other 2 Providers. It is clear that none of you are on the same page and know what happened or what was going on at the time. 

  
  At this point based off of the last and Final Progress Report you sent us dated 03/28/23, from the start date to March 28 you guys only completed just 1credentialing insurance panel - Cigna. That was only after ***** put in a ton of time and effort to follow-up. It is hard to understand how after 6+ months of going back and forth and sending a detailed list of our Project and Panel List (numerous times) and doing our best to communicate and reach out regularly to your company, that your company only managed to work on and complete only 1 panel.  

  That will be the only thing we are willing to pay for since this is the only work that was done.  $250 -$275 per panel was the agreement. It was $250 if we had 15 or more panels which we did (see our Panel List Attached), but none of them were properly worked on or completed. Therefore it should be $250 (at BEST) for this disorganized and unprofessional experience.  We should in reality take this to Small Claims Court and charge your company for breaching the contracting, wasting our time, charging you for our lost time, lost clients and lost revenue because you clearly did not do any of the work within a 6+ month time span. You have no proof of even having started any of the panels except for maybe Cigna, and there is a good chance we started that application as well.    

  
  Regards,
  
  **************

  

  Business response

  06/08/2023

  On the final report you attached you can clearly see that many applications were closed by your request in October of 2020.

  Here is that list: 
  ********************************* BEACON HEALTH Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  ********************************* COMPSYCH Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  BEACON HEALTH Primary Misc. Note Closed
  ********************************* HUMANA Primary Credentialing Application Closed 10/27/2022 closed per clients request.
  ********************************* ** CARE HEALTH PLAN Primary ********************** Application Closed 10/27/2022 closed per clients request.
  ********************************* MAGELLAN Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  ********************************* MHN Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  ************************************ Primary Credentialing Application Closed 10/27/2022 Closed per clients request.

  ********************************* Anthem BC (CA) Primary Credentialing Application Closed 10/27/2022 Closed per clients request.

  ********************************* BCBS PROMISE HEALTH PLAN Primary Credentialing Application Closed 10/27/2022 closed per clients request.

  *************************** MHN Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  ********************************* Primary Credentialing Application Closed 10/27/2022 Closed per clients request.

  *************************** Anthem BC (CA) Primary Credentialing Application Closed 10/27/2022 closed per clients reqeust.

  UNITED HEALTH CARE (UHC) Primary Credentialing Application Not ********************* wanted to require group enrollment but that is N/A as we don't have at least 5 providers
  03/28/2023: Project closed per client request PROJECT WAS NOT CHARGED

  Additionally, we filed several apps that you wanted turned over to you or you closed due to you terminating the contract on March 28th. If we filed the application then we charged you the fee. We charge all of our clients once the application has been submitted to the insurance company Not When It Completes. This is our standard practice. The reason we do this is because the majority of the work is on the front end where we collect the providers information, call each insurance to find the providers status so that the process is started correctly and appropriately according to the insurance company, we fill out the application and file it for processing. After it is filed, it is only follow up calls that will be completed to TRY to get a timeline for completion. Unfortunately, the timelines with each insurance company is quite long, ******* days and in come cases, it could be more. You can see by the status' below that we had filed the application and they were in process.  

  CIGNA Primary Credentialing Application Complete 12/12/2022 12/22/2022 ************ contract is now executed with an effective date of 12/21/2022 for location ******************************** Ste ******* *** Nuys, ** 91401.

  *********************** MHN Primary Credentialing Application Turned Over to Client Submitted App on 09/16/2022 Re-Submitted app on 10/20/2022 Last followed up on 01/23/2023, no ETA given 03/28/2023: Project closed per client request

  MHN Primary Credentialing Application Turned Over to Client Submitted App on 09/16/2022
  10-12-2022 Missing Info: W-9
  10-17-2022 Missing Info: W-9
  Submitted app on 10/20/2022
  Last followed up on 01/03/2023, pending payor response
  03/28/2023: Project closed per client request
  

  *************************** CIGNA Primary Credentialing Application Turned Over to Client 03/16/2027 Last updated
  EverNorth processing through Cigna
  10/27/2022 Submitted application
  01/05/2023 Submitted Online Application for Cigna - EverNorth.
  01/19/2023 EverNorth application is in contract status, Pending agreement from payor
  Last follow up: 03/16/2023
  03/28/2023: Project closed per client request
  

  ********************* Anthem BC (CA) Primary Misc. Note Complete 06/25/2022 06/01/2025 12/23/2022 Approved Effective Date 06/25/2022. Location is ******************************************************************
   Medi-Cal Behavioral Health Network
  ********************* COMPSYCH Primary Credentialing Application Turned Over to Client Initial Outreach on 10/03/2022
  Received app from payor 01/25/2023
  Last Followed up on 03/27/2023
  03/28/2023: Project closed per client request
  THIS PROJECT WAS NOT CHARGED
  

  ************************* COMPSYCH Primary Credentialing Application Closed 10/27/2022 Closed per clients request
  

  ********************* CIGNA Primary Credentialing Application Complete 01/20/2023 01/20/2026 ******* 03/28/2023 Enrollment approved eff 01/20/2023, next recred due date 01/20/2026, provider ID *******
  

  ************************* HUMANA Primary Credentialing Application Closed 10/27/2022 Closed per clients request.
  

  ********************* HUMANA Primary Credentialing Application Turned Over to Client Initial outreach - 10/18/2022
  Submitted App on 10/28/2022
  Re-Submitted app on 11/16/2022
  Payor requested additional info on 02/24/2023
  Additional info submitted on 03/15/2023 
  03/28/2023: Project closed per client request
  

  ***************************** Primary Credentialing Application Turned Over to Client Initial Outreach on 09/12/2022
  Submitted App on 01/05/2023
  Last followed up on 03/14/2023 App is in Process TAT ***** business days
  03/28/2023: Project closed per client request
  

  *********************** ****** UNITED HEALTH CARE (UHC) Primary Credentialing Application Turned Over to Client 12/12/2022: ***** at clients office will complete this since we don't have access to CAQH for provider THIS PROJECT WAS NOT CHARGED
  
  *********************** UNITED HEALTH CARE (UHC) Primary Credentialing Application Turned Over to Client 12/12/2022: ***** at clients office will complete this since we don't have access to CAQH for provider
  

  ********************* UNITED HEALTH CARE (UHC) Primary Credentialing Application Complete 03/08/2023 03/08/2026 008518413-001 Per payor rep application process is complete and provider is in- network. Provider effective date is 03/08/2023, Provider ID is ************* and location ************************************ is added with the provider. Also received an email from payor. Saved in sharepoint. 
  

  *************************** UNITED HEALTH CARE (UHC) Primary Credentialing Application Complete 12/27/2022 12/27/2025 ********** 03/28/2023 Enrollment approved eff 12/27/2022, next recred due date 12/27/2026, provider ID **********
  HUMANA Primary Credentialing Application Turned Over to Client Initial outreach - 10/18/2022
  Submitted App on 10/28/2022
  Re-Submitted app on 11/16/2022
  Last followed upon 02/02/2023, pending response from payor
  03/28/2023: Project closed per client request
  

  ********************* BCBS PROMISE HEALTH PLAN Primary Credentialing Application Turned Over to Client Requesting enrollment for Promise Health Plan.
  

  Initial Outreach on 10/07/2022
  Pending additional provider services & vendor information to submit application
  Last Followed up on 02/27/2023
  APP WAS NOT SUBMITTED TO PAYOR AND NOT CHARGED
  03/28/2023: Project closed per client request
  
  ****************************** Primary Credentialing Application Turned Over to Client 07/26/2022 Client submitted attestation documents
  10/06/2022 payor advised current ETA is 3-6 months for review and agreement to be extended
  12/15/2022, payor advised the group returned a ******** addendum but did not provide a ******** ID#
  Pending ********# to continue processing (We do not have a ******** project for group)
  03/28/2023: Project closed per client request
  

  ********************************* CIGNA Primary Credentialing Application Turned Over to Client 03/16/2023 Last Updated
  EverNorth processing through Cigna
  10/27/2022 Submitted Application
  01/05/2023 Submitted Online Application for Cigna - Evernorth, Pending contract from payor
  Last follow up: 03/16/2023
  
  ********************************* UNITED HEALTH CARE (UHC) Primary Credentialing Application Complete 12/20/2022 ********** Processed through Optum for BH

  Customer response

  06/08/2023

  Complaint: 20072048
  
  I am rejecting this response because: Its idiotic
  
  Regards,
  
  *******************;

   

  Can we focus and get to the point please. Clearly your office is a Circus so you guys have no issue with going back and forth nonsensically without any aim to a solution. 
  We proposed a solution in our last message to your company. We can ONLY pay for work that was COMPLETED. ONLY 1 or 2 panels were COMPLETED. That is all we are willing to pay for. $250 for each AT BEST. Initially we gave your company a list of 15+ panels we wanted to be credentialed with and a detailed list of which panels we had already started, etc. Clearly no one at your company followed that list and practically nothing was started nor completed in a timely manner. We obviously closed the project(s) after 6+ months because NOTHING was progressing forward. We understand that credentialing takes time and it can be a lengthy process, but that is irrelevant if your company did not even start the application processes nor attempt to complete the ones we had already started. Again, we are only willing to pay for the work that was completed (Cigna) $250 
  Otherwise we can file a Small Claims Court Case and we will be demanding money from 1st Credentialing for wasting our time and making us lose clients as a result of your disorganization and NEGLECT. 

  

  Business response

  06/30/2023

  *****,

   

  Shay at the Better Business Bureau said that the invoices you were sent were not clear in the fees. I have attached the invoices here for you to see that when you open the email there is an attachment with all of the details. This includes provider name, insurance whose application we filed and the fee for each service.  

   

  Please let me know if you have any issues opening up the invoices.

   

  *****

  Customer response

  06/30/2023

  Complaint: 20072048
  
  I am rejecting this response because: It is INACCURATE as we suspected the invoices would be. 

  We finally received an invoice breakdown from 1st Credentialing. 
  We were not properly notified of when any of this work was started nor officially completed so we were unable to keep track. Our understanding per signing-up and their initial email to us was that the work was going to begin in August, however nothing was started until October or November. As far as completion, that was another complete mystery. 
  Meanwhile we were charged interest and 'late fees' for charges that we were not even aware of in terms of what they were for or what work was completed despite our numerous requests for 1st Credentialing to communicate with us about what was completed and if possible give us copies of what exactly was submitted.

  (If only they sent us as many Progress Reports as they did random unitemized inaccurate invoices. They never even let us know when a panel was fully complete and that we would be receiving an invoice for that panel.) 
  
  
  I took some time to go over all of the charges in the altogether complete and itemized invoices that we finally received today (6/30/23). 
  I have an issue with the charges as they are inaccurate. 
  I have attached the initial Project request that we initially sent to 1st Credentialing (in Auguat which was supposed to be the start of our Project) for each Panel. Please see below: 
  
  
  Charges: 
  
  
  $130- Anthem - We were already In-Network with Anthem prior to beginning work with 1st Credentialing. We were only interested in joining Anthem commercial PPO. If you can prove that we are in Anthem COMMERCIAL PPO then we will pay OTHERWISE we were already in-network with this panel. 
  
  $275- ******- Would like proof that our organization is in their In-Network database, I mentioned numerous times in my emails to *** that we would like our ****************** In-Network with all of the Panels on our Project List and not just the Provider. The reasoning for this was because the process takes long and on top of that you guys were so disorganized and that made the process take even longer, so our main Provider ********************* already retired. The goal was to have our ****************** in their In-Network Database - We would like proof of this please before we pay. 
  
  
  $1100- United Health: *** didn't even start this until I called her (in late December) to ask if she had started or submitted the application to United Health since we had a patient with this insurance, to which she replied "no" and barely started the process that day. 
  
  
  $1375- Cigna: (I sent the initial application and followed up since *** was not responding to their emails in a timely manner, I received emails from this panel asking if we were still interested in joining because the emails they sent to *** went unanswered and completely neglected). 
  
  
  Humana: I have no proof that anything was submitted for this. We had discussed this with *** during one of our phone conversations and she had mentioned that she was trying to figure out how to submit for this panel and thereafter nothing further was relayed to us regarding the Humana panel.  
  
  
  Magellan: I already submitted the application and Attestation Documents on 7/26/22 which was before we even started working with 1st Credentialing so please don't take credit for work you did not do. (See my Panel List  attached below) 
  
  
  
  
  $550 - MHN: Also already completed by me. The application was fully complete and 1st Credentialing was only supposed to look over it and submit it but we ended up submitting it ourselves because it wasn't getting done.  
  
  
  *As far as the interest and Late fees, we were told upon signing-up that we would just pay when everything was completed. That is what we were initially told when we were filling out the Agreement paperwork, they instructed us to leave the credit card and payment portion of the Agreement blank (which we did). Additionally, we were not notified about when anything was started nor completed. We still don't know what exactly was completed. That's the problem.  
  
  
  
  Total: $3,430  (INACCURATE) 

  

  Business response

  07/13/2023

  *****, 

  I want to address the applications specifically. My responses start with ** on each paragraph

  Charges: 
  
  
  $130- Anthem - We were already In-Network with Anthem prior to beginning work with 1st Credentialing (see attached Project List). We were only interested in joining Anthem commercial PPO. If you can prove that we are in Anthem COMMERCIAL PPO then we will pay OTHERWISE we were already in-network with this panel. 

  **This was not an application fee. We charged an hourly fee for the work involved in verifying the enrollment details for provider *********************, PhD per ****** request. Wed also loaded Anthem projects for two other providers (******************************* & *************************) but did not charge for those since ***** requested we not continue those before initial outreach had taken place. I WILL REVERSE THIS FEE FOR YOU. 
  
  $275- ******- Would like proof that our organization is in their In-Network database, I mentioned numerous times in my emails to *** that we would like our ****************** In-Network with all of the Panels on our Project List and not just the Provider. The reasoning for this was because the process takes long (actually from my experience if you are organized and submit everything and respond to any email/ letter correspondences from the panels in a timely manner, it actually does not take that long) and on top of that you guys were so disorganized and that made the process take even longer (much longer than it needed to), so our main Provider ********************* already retired. The goal was to have our ****************** in their In-Network Database - We would like proof of this please before we pay. 

  **This was one application charge for provider ********************** This group did not have enough providers to qualify for a group agreement with most payors, ****** included.Most payors require 2 providers at minimum to qualify for a group agreement.They only had one provider we were enrolling (the other two ***** asked us not to work on for this payor). We began reaching out to ****** on for ************** in early October. We communicated with this payor 11 times between October and December before we received the application for this provider on 12/27/2022.The application was submitted on 01/05/2023. On 2/15/2023 the rep advised the provider was still in the credentialing phase that must be approved before they would proceed with contracting. We received confirmation of credentialing approval on 3/03/2023 and replied back asking for confirmation on where we were with the contracts. We followed up again on 3/14 to confirm where the payor was with the contracting portion. On 3/28/2023 the project was closed per the clients request (prior to us being able to confirm approval). Wed also loaded Anthem projects for two other providers (******************************* & *************************)but did not charge for those since ***** requested we not continue those before initial outreach had taken place.
  
  
  
  $1100- United Health: *** didn't even start this until I called her (in late December) to ask if she had started or submitted the application to United Health since we had a patient with this insurance, to which she replied "no" and barely started the process that day.  These were three application charges for providers: *********************, *************************, & *******************************. These enrollments were started on 09/28/2023. Some were stalled by the fact that ***** didnt want to accept the individual agreements the payor offered for these providers because she adamant she wanted a group agreement.

  **The payor confirmed they required a minimum of 5 providers in order to extend a group agreement. On 12/08/2022 ***** sent us two more providers (to make the 5 total needed for a group agreement) but then immediately came back on 12/12/2022 when we were adamant we must have CAQH access to complete enrollments for these two providers and she asked us to close these two out (these two were not charged). All three of the original providers were submitted and processed. We received approvals for all three providers.  
  
  
  $1375- Cigna: (I sent the initial application and followed-up since *** was not responding to their emails in a timely manner, I received emails from this panel asking if we were still interested in joining because the emails they sent to *** went unanswered and completely neglected).  *(See attached Project List)  This charge is for 4 applications total (*********************, *************************, *******************************, &Group).  

  **We completed all four applications and submitted to the rep between 10/27-10/31.Dr. ****** enrollment was approved in early March. The projects for both ************************* & ******************************* were closed on 03/28 per the clients request before we could verify completion. The group agreement was executed back in December and we relayed that approval to the client. I do not see any notes indicating that ***** submitted documents instead of us or lapses in the process due to our untimely response. We should not have charged for the group application since we charged for the individuals and this ONE APPLICATION WILL BE REVERSED.

  
  Also we never requested ***** / ******************* and ******************************* to be added to Cigna. They were only supposed to be added to United Health, which I believe they were not. 

  **The information for these providers was sent over to us in early October, 2022 with no indication that UHC was the only enrollment being requested at the time. The Cigna projects for ******* & Arash were not requested to be closed by the client until she requested all work be closed on 03/28/2023.
  
  
  Humana: I have no proof that anything was submitted for this. We had discussed this with *** during one of our phone conversations and she had mentioned that she was trying to figure out how to submit for this panel and thereafter nothing further was relayed to us regarding the Humana panel.   *(See attached Project List) -

  **There was one application charged for *********************. We began reaching out to this payor in early October. They advised there was no agreement on file under the *** and asked that we submit a request for contract before they would begin credentialing the provider. We submitted the contract request on 10/28/2022. On 10/31/2022 we received an ETA of ***** days for a response back from contracting. We received a request for the provider roster and submitted it back on 11/16/2022. We received a denial from the payor on 12/15/2022 advising the panels were closed and we reached out multiple times in an attempt to appeal the decision. On 2/24/2023 we received notice they were only currently extending agreements for their ******** line of business and they requested ******** info for providers.Additional forms were completed and submitted back to the payor on 3/15. The project was closed per the clients request on 03/28/2023 prior to us being able to obtain the contract.
  
  
  Magellan: I already submitted the application and Attestation Documents on 7/26/22 which was before we even started working with 1st Credentialing so please don't take credit for work you did not do. *(See my Panel List attached below)  This was one application charged for *********************. When we originally setup this project, we had it noted that the client submitted the attestation documents to the payor on 07/26/2022. Upon following up with the payor, we were advised that they received all requested information on 08/01/2022, the file was in process and nothing additional was needed at that time. On 12/15/2022 we received a request from the rep for additional information that wasnt previously provided ****************** addendums needed corrections). This information was provided to the payor. This project was ultimately closed out on 03/28/2023 per the clients request prior to us being able to obtain the approval. I WILL REVERSE THIS APPLICATION FEE. 
  
  
  $550 - MHN: Also already completed by me. The application was fully complete and 1st Credentialing was only supposed to look over it and submit it but we ended up submitting it ourselves because it wasn't getting done.  * (See attached Project List) -

  **Upon following up on the application previously submitted by the client, we received notice from the payor on 09/29/2022 requesting corrections to the forms that were originally submitted. They needed signatures on the provider application and an updated W-9. We made those corrections and sent the updated forms to the client for signature. We received the signed forms back from the client on 10/18/2022 and submitted back to the payor on 10/20/2022. On 11/08/2022 the payor advised that ALL forms had to be resubmitted together again, all forms were pulled, reviewed for current dates and resubmitted to the payor. The payor pulled CAQH for processing again on 11/21/2022, after our resubmission. The project was still in follow up when it was closed per the clients request on 03/28/2023.
  

  1st Credentialing will reverse the $130 fee and two application fees which are $275 each, so the total to be reverse is $680. We hope that this will assist you in paying the rest of the balance. 
  
  Thank you.

  Customer response

  07/21/2023

  Complaint: 20072048
  
  I am rejecting this response because: It is NOT satisfactory or correct.
  
  
  
  SEE MESSAGE IN BLUE FROM THE BUSINESS:
  
  
  $130- Anthem - We were already In-Network with Anthem prior to beginning work with 1st Credentialing (see attached Project List). We were only interested in joining Anthem commercial PPO. If you can prove that we are in Anthem COMMERCIAL PPO then we will pay OTHERWISE we were already in-network with this panel. 
  **This was not an application fee. We charged an hourly fee for the work involved in verifying the enrollment details for provider *********************, PhD per ****** request. Wed also loaded Anthem projects for two other providers (******************************* & *************************) but did not charge for those since ***** requested we not continue those before initial outreach had taken place. I WILL REVERSE THIS FEE FOR YOU.
  
  
  Anthem: Please remove this illegitimate and incorrect fee. 
  
  We did NOT request for you guys to "verify our enrollment details". If you look at our Project List we very specifically were requesting to submit an Anthem Application for their Anthem COMMERCIAL PPO. We had already verified our enrollment with Anthem. There are several different types of Anthem Networks  -we were interested in joining the Anthem Network which we were not yet a part of. *I specified this telephonically as well.  
  
  
  
  $275- ******- Would like proof that our organization is in their In-Network database, I mentioned numerous times in my emails to *** that we would like our ****************** In-Network with all of the Panels on our Project List and not just the Provider. The reasoning for this was because the process takes long (actually from my experience if you are organized and submit everything and respond to any email/ letter correspondences from the panels in a timely manner, it actually does not take that long) and on top of that you guys were so disorganized and that made the process take even longer (much longer than it needed to), so our main Provider ********************* already retired. The goal was to have our ****************** in their In-Network Database - We would like proof of this please before we pay. 
  **This was one application charge for provider ********************** This group did not have enough providers to qualify for a group agreement with most payors, ****** included. Most payors require 2 providers at minimum to qualify for a group agreement. They only had one provider we were enrolling (the other two ***** asked us not to work on for this payor). We began reaching out to ****** on for ************** in early October. We communicated with this payor 11 times between October and December before we received the application for this provider on 12/27/2022. The application was submitted on 01/05/2023. On 2/15/2023 the rep advised the provider was still in the credentialing phase that must be approved before they would proceed with contracting. We received confirmation of credentialing approval on 3/03/2023 and replied back asking for confirmation on where we were with the contracts. We followed up again on 3/14 to confirm where the payor was with the contracting portion. On 3/28/2023 the project was closed per the clients request (prior to us being able to confirm approval). Wed also loaded Anthem projects for two other providers (******************************* & *************************) but did not charge for those since ***** requested we not continue those before initial outreach had taken place.
  
  
  ******: Please remove this illegitimate and incorrect fee. 
  
  
  
  We had already submitted a Letter of interest on 7/26/22 (noted on our Project List). Basically nothing was done past that. Not sure what you are charging us for. 
  Further, NONE of any of what you stated was communicated to us. We had NO IDEA that ****** required 2 Providers etc.  *** should have perhaps done the BASIC responsible thing and communicated this to us. We are still not in-network with this payor (******) and I have no idea whether what you are stating you allegedly did was actually done because again nothing was communicated to us along the way, no proof was sent. I asked *** several times to please cc us on email correspondences so we can keep tabs of what is actually being done.  WE sent the Letter of Interest and since then NOTHING has progressed forward and no application was submitted to ****** by 1st Credentialing.  *Additionally you claimed that we sent over the information for ******* and Arash in "October 2022 with no indication that UHC was the only enrollment being requested at the time" [see your Cigna response below] so why didn't you use those additional Providers to move the project forward?  Your responses don't add up. Then you claim that you were missing information for the other 2 Providers in December 2022.  Does NOT add up. 
  
  
  $1100- United Health: *** didn't even start this until I called her (in late December) to ask if she had started or submitted the application to United Health since we had a patient with this insurance, to which she replied "no" and barely started the process that day.  These were three application charges for providers: *********************, *************************, & *******************************. These enrollments were started on 09/28/2023. Some were stalled by the fact that ***** didnt want to accept the individual agreements the payor offered for these providers because she adamant she wanted a group agreement.
  **The payor confirmed they required a minimum of 5 providers in order to extend a group agreement. On 12/08/2022 ***** sent us two more providers (to make the 5 total needed for a group agreement) but then immediately came back on 12/12/2022 when we were adamant we must have **** access to complete enrollments for these two providers and she asked us to close these two out (these two were not charged). All three of the original providers were submitted and processed. We received approvals for all three providers.  
  
  
  United Health: Please adjust and correct the fee for only 2 or 3 Applications (250 x 3) and we will pay the CORRECT fee. 
  
  Again, this was NOT communicated to us correctly. When I reached out to United Health they said that 3 Providers would suffice for a Group. Also, since I did not provide the **** as you claim then why did you submit the Applications? You said you could not submit it without having their passwords but then went ahead and submitted who knows what and are now charging us $1100 ? That charge does not even make any sense, isn't it $250 per application/ npi? 
  
  
  
  
  $1375- Cigna: (I sent the initial application and followed-up since *** was not responding to their emails in a timely manner, I received emails from this panel asking if we were still interested in joining because the emails they sent to *** went unanswered and completely neglected).  *(See attached Project List)  This charge is for 4 applications total (*********************, *************************, *******************************, & Group).  
  **We completed all four applications and submitted to the rep between 10/27-10/31. Dr. ****** enrollment was approved in early March. The projects for both ************************* & ******************************* were closed on 03/28 per the clients request before we could verify completion. The group agreement was executed back in December and we relayed that approval to the client. I do not see any notes indicating that ***** submitted documents instead of us or lapses in the process due to our untimely response. We should not have charged for the group application since we charged for the individuals and this ONE APPLICATION WILL BE REVERSED.
  
  
  Cigna: We can only pay $250 for Cigna. It is not our fault you did not communicate or misunderstood our Project request(s) which we attempted to communicate numerous countless times. 
  
  We had already sent our own Cigna Application on 7/26/22. 
  We did not request to have the other 2 Providers added to Cigna, that was ONLY for United Health since they required 3 Providers (which 1st Credentialing claimed was 5 Providers). 
  
  Also we never requested ***** / ******************* and ******************************* to be added to Cigna. They were only supposed to be added to United Health, which I believe they were not. 
  **The information for these providers was sent over to us in early October, 2022 with no indication that UHC was the only enrollment being requested at the time. The Cigna projects for ******* & Arash were not requested to be closed by the client until she requested all work be closed on 03/28/2023.  
  
  
  *That is not true, I did not send over their npi/ **** etc. until mid December when I contacted *** to follow-up with United Health during which time I found out that she had not even started it.  She then contacted me again and said that we needed additional Providers to submit for United Health, etc. It was at that time that I sent over the information for the other 2 Providers. 
  
  
  Humana: I have no proof that anything was submitted for this. We had discussed this with *** during one of our phone conversations and she had mentioned that she was trying to figure out how to submit for this panel and thereafter nothing further was relayed to us regarding the Humana panel.   *(See attached Project List) -
  **There was one application charged for *********************. We began reaching out to this payor in early October. They advised there was no agreement on file under the *** and asked that we submit a request for contract before they would begin credentialing the provider. We submitted the contract request on 10/28/2022. On 10/31/2022 we received an ETA of ***** days for a response back from contracting. We received a request for the provider roster and submitted it back on 11/16/2022. We received a denial from the payor on 12/15/2022 advising the panels were closed and we reached out multiple times in an attempt to appeal the decision. On 2/24/2023 we received notice they were only currently extending agreements for their ******** line of business and they requested ******** info for providers. Additional forms were completed and submitted back to the payor on 3/15. The project was closed per the clients request on 03/28/2023 prior to us being able to obtain the contract.
  
  Humana- Please remove this illegitimate and incorrect fee.
  We have no proof that you guys did any of this despite our many requests for proof of progress [for ALL panels]. We will not be paying for any of this hocus. 
  WE had sent an initial application on 7/05/22 to Humana and nothing has progressed forward for this panel. 
  
  Magellan: I already submitted the application and Attestation Documents on 7/26/22 which was before we even started working with 1st Credentialing so please don't take credit for work you did not do. *(See my Panel List attached below)  This was one application charged for *********************. When we originally setup this project, we had it noted that the client submitted the attestation documents to the payor on 07/26/2022. Upon following up with the payor, we were advised that they received all requested information on 08/01/2022, the file was in process and nothing additional was needed at that time. On 12/15/2022 we received a request from the rep for additional information that wasnt previously provided ****************** addendums needed corrections). This information was provided to the payor. This project was ultimately closed out on 03/28/2023 per the clients request prior to us being able to obtain the approval. I WILL REVERSE THIS APPLICATION FEE. 
  
  MAGELLAN- Fee Reversed -
  
  $550 - MHN: Also already completed by me. The application was fully complete and 1st Credentialing was only supposed to look over it and submit it but we ended up submitting it ourselves because it wasn't getting done.  * (See attached Project List) -
  **Upon following up on the application previously submitted by the client, we received notice from the payor on 09/29/2022 requesting corrections to the forms that were originally submitted. They needed signatures on the provider application and an updated W-9. We made those corrections and sent the updated forms to the client for signature. We received the signed forms back from the client on 10/18/2022 and submitted back to the payor on 10/20/2022. On 11/08/2022 the payor advised that ALL forms had to be resubmitted together again, all forms were pulled, reviewed for current dates and resubmitted to the payor. The payor pulled **** for processing again on 11/21/2022, after our resubmission. The project was still in follow up when it was closed per the clients request on 03/28/2023. 
  
  
  MHN: Please remove this illegitimate and incorrect fee. 
  We had done the ENTIRE Application already [See Project List]. Additionally, WE followed up and sent the correct W9 (see email proof attached below) NOT 1st Credentialing. 
  
  
  
  
  
  1st Credentialing will reverse the $130 fee and two application fees which are $275 each, so the total to be reverse is $680. We hope that this will assist you in paying the rest of the balance. 
  
  Thank you.
  
  
  
  
  Conclusion:  
  
  
  
  
  Anthem: Please remove this illegitimate and incorrect fee. 
  
  ******: Please remove this illegitimate and incorrect fee. 
  
  United Health: Please adjust and correct the fee for only 2 or 3 Applications (250 x 3) and we will pay the CORRECT fee.  $750.00 
  
  Cigna: We can only pay $250 for Cigna. It is not our fault you did not communicate or misunderstood our Project request(s) which we attempted to communicate numerous countless times. 
  
  Humana- Please remove this illegitimate and incorrect fee. 
  
  MAGELLAN- Fee Reversed - 
  
  MHN: Please remove this illegitimate and incorrect fee. 
  
  
  
  
  
  TOTAL: $1000.00  
  *[Will can NOT pay 'Interest' since payment was also not properly communicated to us].
  
  We were only told at the very beginning to leave the Payment Portion of our paperwork blank because we would pay at the end once everything was completed. Unfortunately we have NO idea when anything was started let alone completed. We still don't know which panel our organization is credentialed with and which panel only our Provider is credentialed with. A breakdown of this would be greatly appreciated. 
  
  
  *ALSO*
  
  
  Can you please tell us which panel our organization is officially credentialed with and which panel only our Provider is credentialed with: 
  
  
  Anthem: ?? ************ credentialed ?? (since you claim you took time and verified enrollment details, etc.  -which we did not request) 
  ******: ?? ************ credentialed ??  -OR- Only Provider ??
  United ********** ************ credentialed ??
  
  Cigna: ?? ************ credentialed ??
  
  Humana- ?? ************ credentialed ??   
  
  MAGELLAN- Fee Reversed - ********************************************* ************ credentialed ??

  Customer response

  09/11/2023

  [A default letter is provided here which indicates your acceptance of Arbitration. If you wish, you may update it before sending it.]

  Better Business Bureau:

  I have reviewed the response made by the business in reference to complaint ID .********, and find that arbitration is necessary.

  Sincerely,

  **************

  

  Business response

  09/11/2023

  [A default letter is provided here which indicates your acceptance of Arbitration. If you wish, you may update it before sending it.]

  Better Business Bureau:

  I have reviewed the response made by the business in reference to complaint ID .********, and find that arbitration is necessary.

  Sincerely,

  **************

• Initial Complaint

  10/20/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I gave 2 stars to be fair as they did get BCBS credentialed although they never sent a contract. ******** gave me a contract but everything was sent to me, 1st Credentialing didn't advise me of anything. Superior withdrew their contract because 1st Credentialing never replied to their email requests. 1st Credentialing then said Superior sent information to me which they didn'***************** 150 days later and no Credentialing.. this all after I reached out to 1st Credentialing is March of 2022 after getting burned by *****************.. I was assured my account would be a priority, it clearly wasn't . I called 1st Credentialing two months ago with significant concerns and my account manager obviously took exception with the request to have another assigned person to handle my account. Needless to say she was retained and I haven't heard a word from her.. finally, they rarely if ever answer emails, they don't answer the phone and they don't return calls but they are quick to take your money ! And if 1st Credentialing is reading this? This is what your lack of service has resorted to. I hope you will do the right thing and provide what I paid for! Update ! October 18th ! closing in on 8 months and no resolution! it was discovered they didn't even file one of my applications and offered a refund which was in fact a service credit! I would have to use their services that would warrant the use of the credit which is never going to happen! other two contracts they claimed were "lost"? clear breach of contract on 1st Credentialing's part. not only has this company cost my organization THOUSANDS, now it would cost my company $1,000s to litigate this matter ! which likely won't be worth it. The harm they have caused my company is inexplicable.

  

  Business response

  11/03/2022

  Tell us wis, I am sorry that you are upset. My team has tried to do all we can to ensure we have been fair with you, up to and including refunding/crediting you for any issues that happened, and we did charge you for the work we processed. We did not lose your We contracts, they were never sent to us. I know that is very frustrating but we never received them. 
  BCBS working on getting contracts. They came back and asked for additional information which *** was preparing. She had some questions and is pending a response from BCBS as to if it applies to Crossroads or not. Once they have that, they should be able to finalize the contracts and get over to us to sign. They are asking for a Supervising Physician and ******** Letter, both are N/A for this client and we are asking if that is ok or not before we send it back. The information requested was not clear as to what did or did not apply to this facility type.
  
  ******** we submitted the initial app paperwork (we have a copy) on 4/20 and have the rep confirmed via email that it was received on 4/20. We then obtained signatures on the agreements and submitted those (we have a copy). Approval letter was sent to client who forwarded to us. If they received/completed anything else on the client end, we were not aware.
  
  ****** we completed the pre-app and submitted requesting enrollment. This is the one we discovered was submitted incorrectly delaying the process. Accounting processed it as a Credit, I notified them to process as a Refund. I do not know if they did that yet or not.
  
  Superior we have confirmed the application is in process, contracts pending. At one point the payor told us the file was closed for non-response from the provider but could not tell us when/where that request was sent. No one on our team had received, we reached out to client to see if perhaps they had received. They had not received either. Later the payor said that contracts were not signed and returned. Again, we had not received nor had the client. We reached back out multiple times and are now being told the application is still in process.
  
  The management team have all been involved and working on this with you. We have asked him to let us know what he has not had a response to so I could address that and he was not able to provide me that information. I also asked that he include me on correspondence as we worked through this so we could ensure response. 
  Credentialing is a very long and frustrating process. Anything remotely looking like an error on our part we have corrected for you. 

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩