We offer quality Credentialing Services for Physicians, Physician assitants, nurse practitioners, Physical Therapists and Social workers at affordable rates. Our aim is to get your medical providers credentialed with best insurance payers. Our medical credentialing specialists offer quick, easy and value adding solution.

credentialing services for Physicians.

Our credentialing services for physicians is focused to enable you to accept every patient by credentialing physicians with best payers in your area so that you can start billing insurance companies right away.

What is Physician Credentialing?

It is process of primary source verification for physician‘s education, experience and other related credentials. It is to ensure that medical provider is competitive enough to render the healthcare services. The same concept is also known as insurance credentialing, medical credentialing and provider credentialing or enrollments.

The objective of medical insurance credentialing process is to make sure that all the information provided by medical provider in his or her physician credentialing application is correct.

This insurance credentialing process helps to minimize the risk of fraud. It is to ensure highest level of patient care from qualified practitioners and improves quality assurance.

A primary source for your educational background could be the medical school you attended in order to earn your medical degree or certificate. For work experience it could be your previous employer to verify expertise of healthcare providers. For licensure it will be your state medical board certification.

It also encompass verification or attestation of training and education through the American Medical Association or the Educational Commission for Foreign Medical Graduates if the medical provider got his medical education outside the United States.

Medical insurance payers can also verify Medicare sanction information from National Practitioner Data Bank on closed and settled claims history.

Provider medical insurance credentialing process is tedious and time consuming process with a lot of requirements. It can take 30 to 120 business days. It also varies payer to payer as some insurances may process your application within 15 days and some may take up to 6 months.

Provider Credentialing Process flow for Physicians?

First Step:

We complete your CAHQ application and upload all the required documents.

Second Step:

We reach out to all the healthcare insurance carriers that you are planning to join and request application packets, complete the paperwork and submit back.

Third Step:

The third step to complete your physician credentialing process is to sign a contract with the medical insurance companies and accept terms and conditions.

Once we complete all above steps, Physician will become an in-network provider. Physician will be able to receive reimbursements from each insurance payor.

We offer comprehensive provider credentialing service by analyzing the top payers in your area. This enables you to improve your cashflow.

credentialing services for Physicians.

BENEFITS OF OUR CREDENTIALING SERVICES FOR PHYSICIANS

COMMON QUESTIONS

The standard time frame for physician credentialing application process is 30-120 business days, Some insurances even take more than 120 days and some process applications within 45 days.

Your dedicated account manager will help you evaluate right payers according to your specialty and location. We help you negotiation contracts in best possible way. Transparent and timely client communication is main focus of our medical credentialing service. We send bi-weekly application status updates.

In general and on average, expect to pay $250-$300 per provider per payer for physician credentialing services.

No, you will have to wait until your medical provider credentialing and contracting application gets approved.

To complete medical provider credentialing process you should have following documents.

  • State License
  • Malpractice insurance
  • DEA certificate
  • Resume
  • Board certificate
  • IRS letter (EIN letter)
  • Business Voided Check
  • General Liability insurance
  • Educational and Professional history of medical provider
  • Article of Incorporation in case of business

We have also given detailed list checklist section. Do scroll down to check that.

Yes & No.

It depends on your specialty, patient volume and state you are practicing in but it is always recommended to complete your Medicare provider enrollment process before applying for other insurances.

It depends on multiple factors such as your Specialty, The state you are practicing in and the Insurances you are applying for.

We can help you get your individual or business NPI within 24 hours for FREE of Cost.

Yes, you will either get an approval letter via mail or an email from medical insurance payer on approval of your physician credentialing application.

WHY YOU SHOULD OUTSOURCE MEDICAL CREDENTIALING?

No doubt that medical credentialing is an important aspect for running a successful medical practice. You can hire a provider credentialing specialist or outsource the process to right credentialing service provider company.

Our experience helps you save time and money.

We Can Save Your Time by Avoiding Following Major Mistakes.

  • Submitting provider credentialing applications with erroneous data.
 
  • Submitting credentialing applications to wrong departments.
 
  • Submitting multiple applications.
 
  • Incorrect contracting or unable to understand the provider contract with insurance payers.
 
  • Irregular follow ups.
 
  • Provider enrollment with HMOs & PPOs without completing Medicare & Medicaid enrollment
 
  • Signing an insurance contract without even reviewing it.
 
  • Accepting the fee schedules from insurance companies as it is where it can be negotiated.
 

How to Choose Best Credentialing Company?

credentialing services for Physicians.

Choosing best credentialing services company for physicians can help you grow faster. It saves lot of time and effort you need to put to achieve physician credentialing goals.

The best company should always meet the deadlines. Delaying provider credentialing will not only effect your cash flow but over all operations as well.

The dedicated expert from best credentialing service company should evaluate and suggest top medical insurance payers in your area.

Segmenting and prioritizing medical insurance credentialing application process is key to success.

Medical insurance credentialing company should handle all re-validation or rec-credentialing tasks.

The company should be able to provide bi-weekly application status reports and charge competitive fee for insurance credentialing services.

Our Medical credentialing services include

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Why physician credentialing is so important?

Physician credentialing is important to build a patient network. No matter what specialty and caliber you have, in order to gain a good patient volume you need to be listed on the insurance panels.

Healthcare insurances will only refer their patients to you if you are one of their participating or in-network medical provider.

You revenue cycle depends on physician credentialing.

Patients are the most basic need of a your medical practice so to make sure that you are not losing a single patient you should get into every insurance plan that is available in your area.

In simple words, it’s all about your cash-flows, if you have an existing medical practice or planning to start one, you should be well aware that all your plans run around cash-flows, which is dependent on proper provider enrollment process execution.

Right provider credentialing services enables you to accept more patients.

Provider credentialing with insurance payers is the first step to generate continues & healthy cash-flows.

Provider Credentialing ensures that you accept all the patients. You will not have to say “NO” to any patient as you don’t accept that healthcare insurance they have.

In-network contracting helps you build strong brand.

Provider credentialing paves your way to payer network contracting, which means you will be get patients from other physicians from same network, this helps strengthen the relationship and build reputation with other providers & more patients.

Payer in-network contracting ensures more revenue for in-network providers

Insurance credentialing has direct impact on your business plan.

If you will not get yourself or new hires credentialed in timely fashion, you will not be able to bill the insurance payers.

It may push you to plan cash arrangements from other resources.

While creating your medical practice business plan, always keep in mind the time it will take to get your in-network reimbursements for patients treated by newly credentialed providers. Outsourcing physician credentialing process to right company can help you make best estimate.

Further you should also consider from what date newly hired medical providers can start seeing patients as if you will start billing for their patients on a future date, You need to know the cutoff date from where the payer can cover your past bills.

Commercial plan contracts do not have any retroactive billing provisions, so you will only be able to receive full reimbursement after your effective date.

Physician Credentialing Checklist

Once you are ready to start medical provider credentialing process, keep your documents ready related to following areas.

  •  

Physician information

Provider Name

NPI

Specialty 

SSN

DOB

Provider Birth Country & State

Contact Number

Home Address

CAQH User Name & Password

NPPES User Name & Password

Office Hours

Practice information

Practice Name

Tax ID

Practice NPI

Practice Specialty

Service location 

Mailing Address                                

Practice Phone Number

Practice Fax No

Owner information

Ownership Percentage

Owner Name

Owner DOB

Owner SSN

Owner Home Address Owner Cell 

Owner NPPES User Name & Password 

Owner Birth Country & State

WE HANDLE BUT NOT LIMITED TO

  • Clinics credentialing
  • House calls credentialing
  • Private practices credentialing
  • Telemedicine credentialing
  • Surgery centers credentialing
  • Hospital Privileges
  • IPA Affiliations
  • Hospitals credentialing
Medical Credentialing services

MEDICAL INSURANCES WE COVER

Federal Plans like Medicare, Medicaid, Tricare, etc.

National Plans such as Aetna, Cigna, BCBS, UHC, Humana etc.

All Managed Care & Regional Plans.

HOW DO WE SERVE

1-Contact

Simply explain what you want & leave your contact details. We will get back to you at our earliest.

2 - Information

After reviewing your query, we will get back to you as soon as possible to have clear idea regarding your requirements as well as we will help you to prepare specific documents required to complete the application.

2 - Submission

On your Go Ahead call, Our expert will update and submit the application to related departments.

Dedicated Manger will follow up with all verification resources as well as keep you posted regarding updates.

 

AFFORDABLE FEE

Get Following Covered for Only $ 250 per Month per Provider

  • Life time support
  • Get Credentialed with as many insurances as you want
  • NPI registration & Maintenance
  • CAQH Registration & Maintenance
  • Medicare & Medicaid Enrollment
  • Credentialing & Re-Credentialing with Commercial and HMOs.
  • Contracting & Negotiations
  • Direct Deposit Setups to avoid extra workload.
  • Demographic Updates.
  • Quarterly Directory Verification

WE LOVE TO HELP

Leave your question & contact. We will get back to you at earliest.

Contact us

Must Read Before Making Final Decision.

Understanding Physician Credentialing Costs.

To manage it in economic way. You need to understand the activities that consume credentialing costs. Building the understanding will enable you to make the best decision regarding effective and efficient management of payer credentialing costs.

Lets figure out, what activities fall under provider credentialing services?

Main activities performed in physician credentialing process.

Knowing this is super important. Identifying activities performed under credentialing will help you understand following.

  • What are main tasks to be performed?
  • How much time each task takes to be completed successfully?
  • What if you don’t get it right at first place?
  • What caliber of resource you will need to perform this job right at first place?
  • How much it will cost you doing it in-house or outsourcing?
 

The main activities to be performed for credentialing specialist are as follows.

 

  • Initial setup, completion and maintenance of CAQH profile for a physician.
  • Credentialing for new payers in-case new physicians are added to medical practice.
  • In-Network contracting after negotiating with insurance companies in order get more what favors the medical provider or medical practice.
  • Tracking document expiry for physicians such as medical license, malpractice insurance, DEA registration and others.
  • Additions and deletions for joining and leaving physicians in a medical practice.
  • Hospital affiliations.
  • Demographic updates.
  • EIN Setup.

How much does insurance credentialing cost?

As you are well aware of the fact that insurance credentialing is time taking process. It involves from document expiry tracking to add and remove new physician in your medical practice.

If you have 10 physicians and do it in-house with one employee. Your minimum cost will be USD 4,000 per month. If you outsource then cost can be as low as USD 2,000 per month.

Here is How?

Provider credentialing costs with one in-house employee

Lets assume, you have ten physicians at your medical practice setup. You decide to hire one full time credentialing specialist to handle all provider credentialing activities.

The ideal candidate should have at least 5 years of experience with mid level medical practices. USD 4,000 per month is average pay for this profile.

Moreover you may be responsible for other employee benefits as per the prevailing law in your state. Even if you assume that you will be only paying USD 4,000 per month still there can be costs such as work station maintenance, IT infrastructure etc.

physician credentialing costs

Medical credentialing costs if outsourced.

In order to minimize credentialing costs and maximize the good results from credentialing, outsourcing is a trending option.

We can serve you at USD 250 per month per provider. You can get your providers credentialed with as many payers as you want. We will handle each and everything which come under medical credentialing services.

Lets assume you have 10 physicians and no one is credentialed with any payer. You will have to pay USD 250 per month per provider for 6 months as within this time line, all of your practitioners will get credentialed with all major payers in your area.

Then you can keep us for maintenance only by paying as low as USD 150 per month per provider.

This will bring your total cost to (250*10*6)+(150*10*6)= $ 24,000 for the first year. In the second year this cost will depend on the number physicians leaving and joining your medical practice.

If the joining medical provider or doctor is already credentialed with major payers. You would just have to add it to your practice. However, if the new provider is not credentialed at all then you will have to invest more time and resources.

However its still better than hiring an employee and paying fixed costs.

Medical credentialing cost

How to minimize insurance credentialing costs?

You can only minimize these costs by choosing right provider credentialing company.

The best provider credentialing company should have following qualities.

  • Timely follow-ups
  • capable of advising best payers in your location
  • capable of segment and prioritize applications
  • experienced team
  • Meeting deadlines
  • Status reports

Final words on cost.

You can always do it yourself but doing it right in first place is key to success. Therefore doing it wrong and learning will consume too much of your time.

Do check our ultimate guide on how to file your Medicare enrollment application.

Choosing the right physician credentialing service company to outsource is the best way to get most of your investment on credentialing.

If you have any question do write us at support@rxcredentialing.com

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Summary
Physician Credentialing Services
Service Type
Physician Credentialing Services
Provider Name
RxCredentialing LLC,
United States of America, Telephone No.1-716-919-3969
Area
United States of America
Description
Get quality physician credentialing services to ensure healthy revenue. We find and suggest top payers in your area. Quick approvals with 100% success rate. Contact now for free consultancy.