Provider Enrolment Services / Medical and Physician Credentialing Services
Physician credentialing and provider enrolment services is a process of enrolment and attestation that a physician is part of a Payer’s network and authorized to provide services to patients who are members in the Payer’s plans.
- PECOS
- NPI Registration (Type I and Type II)
- CAQH Registration
- Medicare and Medicaid Provider Enrolment and Credentialing
- Medicare and Medicaid Revalidation
- Commercial Insurance Provider Enrolment and Credentialing (ie. Aetna, Anthem, BCBS, CIGNA, TriCare, Humana, UnitedHealthcare, Superior Health Plan, Molina Many More!)
Provider Enrollment and Credentialing Services
Physicians/providers must credential themselves, i.e., enrol and attest with the Payer’s network and authorized to provide services to patients who are members of the Payer’s plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.
Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively.
Our customized Payer credentialing and enrolment services support physicians in:
- Starting or joining a new practice
- Switching from one physician practice group to another
- Join or become affiliated to new groups or practices
- Enrol with new payers
- Maintain their credentialing services.
Our Solutions CREDENTIALING PROCESS INVOLVES THE FOLLOWING:
Collect all the data and documents required for filing credentialing applications from the physicians
- Store the documents centrally on our secure document management systems
- Understand the top payers to which the practice sends claim and initiate contact with the payers
- Apply the payer-specific formats after a due audit
- Timely follow-up with the Payer to track application status
- Obtain the enrolment number from the Payer and communicate the state of the application to the physician
- Periodic updates of the document library for credentialing purposes