Insurance Credentialing, also called medical or physician credentialing; Physicians and other healthcare practitioners who wish to bill an insurance company and receive reimbursement for services as an in-network provider must undergo a process of credentialing in which the insurance company verifies the providers education, training, experience, and competency and assign a specific provider number to the application.
When You Need Credentialing
- New Provider:
So you’re a new provider, and you’re ready to see your first patient. Not so fast! If you plan to accept insurance, you must credential with most insurance companies to receive reimbursement. We will help you credentialing and contract with the insurance companies of your choice.
- Starting a New Practice:
Maybe you were credentialed and contracted with your previous company. So many providers assume the credentialing and contracts will follow them to their new practice. This simply is not true. When a provider changes tax-id, often times new contracts will need to be obtained. If you change states, the credentialing must start from the beginning in the new state, if for national insurance companies. We can help get you credentialed and obtain new contracts under the new tax-id or your social security number.
- Adding a New Providers:
Your practice is growing, and you need to add providers. Some insurance companies will require group contracts for practices with more than one provider. Each provider will need to be credentialed and either added to the group contract, or have an individual contact that will pay to the practice tax-id. We can help make sure each provider has completed the necessary application and contracts to ensure your practice is paid for services rendered.
- New Insurance Company:
At some point, your practice may decide to accept new insurance payers. This will require establishing contracts with the new insurance company. We can help you establish contracts and review the fee schedule for the new insurance company.
How It Works
- Sign Up > Sign up for credentialing service by accepting a formal services agreement and BAA (Business Associate Agreement) which comply with HIPAA
- Data Collection > We collect all pre-requisites from physicians for filing credentialing application to insurances using HIPAA compliant platforms such as FTP etc.
- Submit Application > We Submit the completed credentialing applications to insurances and save a copy of it for future references for each insurance.
- Follow up > We call to insurance carriers on regular basis to track the status of application, provide insurance carriers additional information right away if demanded.
- Get provider Number > We obtains contracts and provider number from insurances with effective date and communicate to provider or billing staff.
Where We can help
- NPI New Application
- NPI Update
- State License Application and Renewal
- DEA application and Renewal
- CAQH creation and maintenance including re-attestation and documents submission
- Medicare Enrollment
- Medicaid Enrollment
- Insurance Credentialing and Re-credentialing
- Hospital Privileges