Provider Credentialing & Enrollment
the correct medical credentialing can save your business, budget and credibility
Redefining the Way You Work
Physician credentialing and enrollment might take a lot of your time and revenue. And when you’re involved in all this heavy lifting, you neglect the operations that need your attention the most. That’s where our physician credentialing and provider enrollment services come in need.
To define it in simple words physician credentialing states that a physician is authorized to provide services to patients belonging to the Payer’s plan.
It’s important for physicians to get themselves credentialed by becoming a verified expert who’s also attested with the insurance’s network and is eligible to give services to the patients of Payer’s plan.
However, to get verified as a physician, you should have your license, past training, education in the field, certifications, affiliations, and clinical judgments.
As the process is long and tedious, it requires a lot of paperwork. However, the paperwork varies from payer to payer, requiring repetition where necessary. Also, it requires you to take follow-ups and sometimes you also need to re-credential to get off through the process.
We keep you away from all these hassles by taking the work on us. By giving us the responsibility, you can be assured that the work will be done with perfection, precision, and accuracy.
Credentialing Included but is not limited to:
- Hospital Enrollment Services
- Practice Setup, TAX ID registration
- Medicare and Medicaid Enrollment
- Credentialing or Re-credentialing
- Contracting for workers comp, commercial insurance, government plans and networks
- Negotiation of Fee for workers comp, commercial insurance and networks
- CAQH Application
- Application of Individual NPI
- Application of Group NPI
- State License, CDS, DEA etc
- EDI Enrollment Setups for 835 and 837
- ERA and EFT Setup
- Management of Insurance Web Portals
Physicians who aren’t credentialed and enrolled with the Payer’s network, might result in late payments or no payment at all. The impact can result in loss or negative results. With our customized provider credentialing and enrollment services, we support healthcare professionals to start a new practice, changing from one practice to another, quick enrolment with new payers, affiliation with new practices and maintaining credentialing services.
What You Will Get With The Credentialing Process?
- Collection of data and documents required for filling applications
- Document Storage in the central location in our document management systems
- Initiate contact with the payers and understand the in-demand payers to which the practice sends the claim
- Apply the payer-specific formats after a due audit
- Tracking of application status with routine follow-ups
- Receiving enrollment number from the Payer and communicating to the physician about the status of the application
What You Will Get With Our Provider Credentialing Services?
CAQH Attestation
CAQH helps you eliminate monotonous processes between health plans and providers by streamlining the data and making it accessible for credentialing purposes and also for directory maintenance and other important business functions.
- Filing the application
- Quarterly attestations
- Expirations and Renewals
- Tracking and Analytics
- Document maintenance
- Contracting agreement maintenance
- Tracking dates and status to start the process of credentialing
- Working on credentialing issues
New Registrations of an Individual Provider
- With the State
- With the Drug Enforcement Agency (DEA)
- Provider Data Maintenance and Management on Payer Systems
- Provider demographic update in payers file.
- Provider directory maintenance on payer websites.
- EFT/ERA enrollments
Contracting Creation and Maintenance
Individual or New Group Practitioner contracts
Including or Omitting providers in the existing contract
Including or Omitting location in the latest contract
Including or Omitting plan types in the latest contract
Price Settlement
Are the Credentialing and Enrollment Services worth Taking?
Our dedicated team can help you get the following advantages with our credentialing and enrollment services.
Quick credentialing
Improved cash flow and reduction in denials claim
Increase in patient referrals from the network
Saves your time and effort by helping you avoid paperwork
Takes you to the efficient filling of application forms
Cost-effective
Timely Reporting on the status of applications
How Much Do Our Services Cost?
Generally, physician credentialing services cost between $1500 – $4000/year. On average, it cost $100-$250/ physician but the cost also varies according to the credentialing service providers. If you’re just starting, the initial setup can cost $150-$500 and per panel, you can expect around $100 for an application.