Credentialing & Enrollment Solutions

Streamlining Provider Credentialing & Enrollment for a Better Healthcare Experience

Whether you’re a healthcare facility, insurance company, or government agency, we have the tools and expertise to ensure that your provider enrollment and credentialing needs are met quickly and effectively. Trust us to handle the complex and time-consuming task of credentialing, so you can focus on providing quality care to your patients.

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Our Provider Credentialing Process

Documentations

Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.

Payer Submission

Identify relevant payers and file for provider credentialing while adhering to the payer-specific format.

Ensure Enrollment

Follow up on applications, tracking status, and ensure the application is submitted correctly.

Periodic Updates

Updating documents library consistently in HIPAA compliance with the credentialing process.

Streamline Your Provider Enrollment and Credentialing Process

We understand that starting a medical practice can be a challenging process, especially when it comes to generating revenue. That’s why we offer a comprehensive provider enrollment and credentialing service to help streamline the process and get you up and running quickly. Our credentialing team is dedicated to helping you navigate the complex world of healthcare payers, from application evaluation to maintaining your data per policies and CAQH profile. We begin by gathering all necessary provider enrollment documents and submitting them on your behalf to insurance companies.
Our provider enrollment and credentialing services ensure that you meet all state and federal regulations for providing healthcare services. Our team will be with you every step of the way, from application to follow-up, to ensure a smooth and efficient enrollment process.

Our Credentialing Services Includes:

Our medical credentialing services are here to simplify the provider enrollment process for you, whether you’re a new provider or looking to get re-credentialed with insurance companies.

Medical Credentialing

We process seamless and smooth medical credentialing applications for healthcare providers.

Re-Credentialing

Updating documents library consistently in HIPAA compliance with the credentialing process.

Contract Renegotiation

Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.

EDI Enrollments

Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.

IPA Enrollment

Identify relevant payers and file for provider credentialing while adhering to the payer-specific format.

Contracting Issues

We resolve contracting issues, address issues, verifications, credentialing requirements and detailed reports of coverage.

Data Integrity

Updating documents library consistently in HIPAA compliance with the credentialing process.

Updates or Changes

Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.

Dedicated Team

A team that completes the credentialing details and submits it to commercial Insurances, Medicare and Medicaid, as requested by healthcare physicians.

Compliance

Our Credentialing Services ensure compliance with the National Committee for Quality Assurance and the Department of Health and Family Services.

Crucial Follow-Ups

Our provider credentialing and enrollment services ensure that all follow-ups are performed properly for a smooth application process.

Maintenance of Data

Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.

Difference Between Provider Credentialing and Provider Enrollment

Provider credentialing and provider enrollment are related but distinct processes in the healthcare industry. Provider credentialing refers to the process of verifying and validating the qualifications, education, and experience of healthcare providers (e.g. physicians, nurses, etc.) who wish to be part of a network of providers that a payer, such as an insurance company, will reimburse for services rendered. The process typically includes a thorough review of the provider’s education, training, licensure, and work history, as well as any malpractice claims or disciplinary actions. The goal of this process is to ensure that the provider is qualified to provide the services they are offering, and that they adhere to the standards and guidelines set by the payer.
The provider enrollment process, on the other hand, is used to add a provider to a payer’s network. This includes assigning them a unique identification number, which is used to bill for services provided to patients covered by the payer. The provider must typically submit an application to the payer, which includes detailed information about their practice, such as the types of services they offer, their location, and the names of other providers who work with them. The payer will then review this information and determine whether to approve the provider for enrollment in their network.
Both provider credentialing and provider enrollment are essential steps in the healthcare reimbursement process. Providers must be credentialed to prove their qualifications and to be approved for enrollment in a payer’s network in order to bill for services provided to patients covered by that payer. The process of provider credentialing and provider enrollment are usually done by the insurance company or the healthcare organization where the provider wants to work with, but in some cases, there are also third party companies that provide these services.

5 Common Challenges in the Medical Credentialing Process

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Leading Credentialing Specialist

Why Choose Us

Our credentialing and enrollment services offer a wide range of benefits to healthcare providers. Here are few reasons why you should choose a Professional Credentialing and Enrollment Services:

Provider Credentialing and Enrollment Checklist

When submitting the official credentialing application, it is important to ensure that all necessary information and supporting documents are included. It’s important to note that the requirements may vary depending on the payer or healthcare organization, so the physician should carefully review the requirements provided by the payer or organization before submitting the application.

Download below our attention to detailed provider credentialing and enrollment checklist before you start your application. 

Streamline the Credentialing Process

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Let us alleviate the burden on your healthcare organization by handling your credentialing process from beginning to end. Want to know more? Get in touch with us now.
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