Medical Credentialing Services
We offer medical insurance credentialing services for all specialties for sole practitioners, small groups as well as huge medical organizations. When a provider wants to participate in health plan networks to treat insured patients and receive in-network reimbursement, the provider must go through a credentialing and contracting process with each health plan. This process is referred to as “Provider Credentialing”. It is a regulated process of accessing the qualifications of specific types of providers which usually involves gathering information about the physician’s background and qualifications.
What is Credentialing?
Credentialing is actually a two-part process i.e. Credentialing and Contracting. The entire process can take anywhere around 90-120 business days. The process can be long, and very complicated. Credentialing is the first part, where a payor or a medical insurance company verifies the data that we provide them via CAQH, then a committee goes through the entire documentation and approves the submitted request for contracting. In the Contracting process, a fee schedule is assigned which is a complete listing of fees used by health plans to pay doctors or other providers for their provided services. Once the fee schedule is approved by a provider, the actual medical contract gets executed.
Why is Medical Credentialing and Insurance Credentialing important?
Medical credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. In today’s medical marketplace, accepting potential patients’ insurance plans is crucial for the success of healthcare practices big and small. Put simply, if potential patients can’t use their insurance plans at your practice, patients are likely to “vote with their feet” and find a competing provider who will. Unfortunately, medical credentialing can be an unwelcome distraction from providing quality care to patients - but it doesn’t need to be. We offer Expert Medical Credentialing for all types of providers.
Our Medical Credentialing Services Include
Credentialing Services
Credentialing Services
Enrollment Services
Enrollment Services
Dedicated Team
Dedicated Team
Crucial Follow-ups
Crucial Follow-ups
Yearly Maintenance
Yearly Maintenance
Assessments
Yearly Maintenance
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