Expert medical coding and seamless provider credentialing designed to maximize your revenue and ensure full compliance. We streamline your practice operations by handling complex payer enrollments and delivering precision-driven billing solutions.
Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.
Identify relevant payers and file for provider credentialing while adhering to the payer-specific format.
Follow up on applications, tracking status, and ensure the application is submitted correctly.
Updating documents library consistently in HIPAA compliance with the credentialing process.
We process seamless and smooth medical credentialing applications for healthcare providers.
Updating documents library consistently in HIPAA compliance with the credentialing process.
Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.
Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.
Identify relevant payers and file for provider credentialing while adhering to the payer-specific format.
We resolve contracting issues, address issues, verifications, credentialing requirements and detailed reports of coverage.
Updating documents library consistently in HIPAA compliance with the credentialing process.
Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.
A team that completes the credentialing details and submits it to commercial Insurances, Medicare and Medicaid, as requested by healthcare physicians.
Our Credentialing Services ensure compliance with the National Committee for Quality Assurance and the Department of Health and Family Services.
Our provider credentialing and enrollment services ensure that all follow-ups are performed properly for a smooth application process.
Collect, validate and securely store all imperative physician data in our database with HIPAA compliance.
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.
Understanding these hurdles helps providers prepare and avoid common pitfalls.
The application and verification process for medical credentialing and enrollment can involve a significant amount of paperwork, which can be complex and time-consuming for providers to complete.
Providers may inadvertently submit inaccurate or incomplete information on their applications, which can delay the process or result in their application being denied.
Providers may find it difficult to understand the requirements and guidelines for medical credentialing and enrollment, as well as the status of their application.
The medical credentialing and enrollment process can take several weeks or even months to complete, and delays can occur due to a variety of reasons such as backlog in processing, missing documentation, or incomplete information.
Different payers and healthcare organizations have different requirements for medical credentialing and enrollment, which can be confusing for providers and make it difficult for them to navigate the process.
Download below our attention to detailed provider credentialing and enrollment checklist before you start your application.
