Physicians/providers must credential themselves, i.e., enroll and attest with the Payer’s network and be authorized to provide services to patients who are members of the Payer’s plans. The credentialing process, in which the Payer confirms the physician's education, license, experience, certifications, affiliations, malpractice, adverse clinical events, and training, validates that the physician meets standards for providing clinical treatment.
Payers have the right to delay or refuse payments to physicians who are not credentialed and enrolled with them. These have a negative impact on the practice's cash flow.
Our specialized Payer enrollment and credentialing services assist physicians in:
- Establishing or expanding a new practice
- Transferring from one physician practice group to another.
- Join or become affiliated with new organizations or practices.
- Sign up with new payers
- Continue to provide credentialing services.
Our credentialing process involves the following:
- Gather all of the data and documents needed from physicians in order to file credentialing applications.
- Centrally store the documents on our secure document management systems.
- Learn about the top payers to whom the practise sends claims and make contact with them.
- After a thorough audit, use the payer-specific formats.
- Follow-up with the Payer on a timely basis to track application status.
- Obtain the Payer's enrolment number and inform the physician of the status of the application.
- Periodic document library updates for credentialing purposes.
Our provider credentialing services include:
Individual Provider New Registrations/Renewals
- With the state
- Together with the Drug Enforcement Agency (DEA)
Provider Data Maintenance - Payer System Update Management
- Updated provider demographics in payers' files. (Provider specialty updates or additional educational qualifications)
- Upkeep of provider directories on payer websites. (Checking payer website and verifying provider information such as phone and fax number, zip code. Updating payers on the correction)
- Enrollment in EFT/ERA
Creating and Maintaining Contracts
- New contracts for group and individual practitioners
- Adding or removing service providers from the current contract
- Modifying the contract's location by adding or removing it
- Modifying the present contract's plan types (Line of Business) by adding or removing them
- Rate Negotiation
Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative processes between health plans and providers for credentialing, directory maintenance, coordination of benefits, and other essential business functions.
- CAQH application submission
- CAQH quarterly attestations
Expirations and Renewals
- The tracking expiry date for the State DEA licence, the Board certificate, and the Malpractice Insurance.
Tracking and Analytics
- Keeping track of a provider's certification records in a repository
- Upholding Contractual commitments
- Monitoring the expiration, alerting, and credentialing dates to start the processes
- Working with the denials team to determine if any claim denials are attributed to credentialing problems
Our credentialing and enrollment services have many advantages:
You will receive the following benefits from our diligent credentialing and enrollment services:
- Get credentialed faster with all major payers.
- Lower claim denials and increase cash flow
- Increase the number of patient referrals from the network.
- With our document management system, you can avoid stacks of paperwork.
- Obtain assistance in completing time-consuming application forms.
- Lower the cost of credentialing with our global delivery teams.
- Receive timely updates on the status of your applications.