PROVIDER CREDENTIALING
We recognize the crucial role physician credentialing plays in the revenue cycle and the overall success of your organization. In fact, it directly impacts the revenue you collect. Our philosophy is simple: Credentialing Data = Revenue. Accurate and proper credentialing is vital to ensure correct payment.
With a nationwide presence and extensive experience working with diverse payor and provider organizations, we offer professional medical credentialing services to help you optimize every dollar. Whether you are part of an academic medical center, health system, hospital-employed provider, or large group practice, our expertise in collaborating with credentialing departments across the United States guarantees that you'll receive the most effective credentialing solution tailored to your organization's needs.
The Better way to get Credentialed
Ease the burden of credentialing and accelerate enrollment with assurance.
Address staffing hurdles, expedite physician onboarding, and hasten the revenue cycle.
Rely on a trusted partner to handle all your credentialing requirements.
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Why Practices
trust our Credentialing
Transparent Reports
Step-by-Step Guidance
Reliability
Network Research
For your group or practice, we guarantee the most diversified, well-liked, and efficient in-network payer mix.Our team contacts each payer you have shortlisted and obtains exact timetables and open panel availability because we have vast expertise enrolling physicians with Medicare, Medicaid, and Private Payers nationwide.
Application Filing
We send you an exhaustive list of all the details and materials needed to submit the applications. Our enrollment staff submits the necessary contract applications as soon as the information is received, making sure the submission is perfect the first time. Our clients receive contracts in the shortest amount of time because of our vast knowledge and application submissions that are accurate the first time.
Application Follow up
Our team checks in on the filed application every two weeks to make sure it has been received, is in the payer's system, that no further information is needed, and that everything is going according to plan. Until the contract is delivered to your physical address, we follow up frequently.
Annual Credentialing Maintenance
Accurate provider database management is essential for healthcare facilities that house several different providers. On our credentialing portal, we oversee and maintain the credentials for all of your providers and doctors. A thorough, open, HIPAA-compliant tool that is specially made to guarantee the maintenance of your database with maximum effectiveness.
PECOS and CAQH Set-up and Maintenance
We negotiate fee rates for you in addition to getting you a contract. We keep an exhaustive database of all payers' most recent fee schedules.We research the competition to make sure we secure the best prices for your operations, securing the highest potential reimbursement for your medical practice. In order to obtain higher rates from the payer at the present moment, we also revisit your prior contracts.
Contract Negotiations
We negotiate fee rates for you in addition to getting you a contract. We keep an exhaustive database of all payers' most recent fee schedules. We research the competition to make sure we secure the best prices for your operations, securing the highest potential reimbursement for your medical practice. In order to obtain higher rates from the payer at the present moment, we also revisit your prior contracts.
Appeals for Closed Panels
Some payers, like UHC, Aetna, and BCBS, have closed panels for a specific region.In such a case, senior provider officials at that payer receive a thorough appeal outlining the important features of your service, including niche offerings and information on how you provide great patient care in your region. Although it is challenging to reverse a closed panel decision, our appeals procedure has had a 30% success rate.
Out-of-network Enrollments
Our staff assists providers with out-of-network enrollments and NPI registrations on the payer's website if they are required to do so because of closed panels or if they wish to do so with some payers.By doing this, the physician's office can start taking out-of-network payments and is guaranteed to be in the payer's system.
Demographic Changes
We provide assistance with all simple and complicated demographic changes, including updating a new TAX ID with all of the payers in your payer mix, a new address, a bank account, etc. Additionally, we assist with complete ERA and EFT enrollment setup.