Physician Credentialing Services

Physician credentialing services for medical providers and healthcare professionals

Get Best Physician Credentialing Services at No Upfront Fee.

Get Your Physician Credentialing Application Approved Quickly. We provide quick, easy and step by step solution.

Our best practice enables you to accept every patient by credentialing physicians with major payers in your area.

What is Physician Credentialing?

Physician credentialing 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 objective of physician 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 that patients get highest level of care from safe hands.

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. For licensure it will be your state medical board.

It also encompass verification 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.

Physician 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.

How Does Physician Credentialing Process Works?

First Step:

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

Second Step:

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

Third Step:

The third step to complete your physician credentialing process is to sign a contract with the medical insurance company 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 payer.

We deliver comprehensive service by analyzing the top payers in your area. This enables you improve your cashflow.

PHYSICIAN CREDENTIALING PROCESS FLOW.

BENEFITS OF OUR PHYSICIAN CREDENTIALING SERVICES

QUESTIONS ABOUT PHYSICIAN CREDENTIALING SERVICES

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 physician credentialing service. We send bi-weekly application status updates.

If you are paying more than $300 to $500 per provider per payer. You are wasting money. We can help you reduce this cost drastically.

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 certificate
  • 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 PHYSICIAN CREDENTIALING SERVICES?

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

Our experience helps you save time and money.

Our Physician Credentialing Service Can Save Your Time by Avoiding Following Major Mistakes.

  • Submitting provider credentialing applications with erroneous data.
 
  • Submitting physician 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 as it is where it can be negotiated.
 

How to Choose Best Physician Credentialing Services Company.

How to choose best credentialing company.

Choosing right medical insurance credentialing company can help you grow faster. It saves lot of time and effort you need to put to achieve physician credentialing goals.

The best physician credentialing 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 physician credentialing 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 physician credentialing services.

Our physician 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 service execution.

Right physician credentialing services enables you to accept more patients.

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

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.

Physician 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

Its worth considering while creating 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

Physician Credentialing Services for

  • Clinics
  • House calls
  • Private practices
  • Telehealth or Telemedicine setups
  • Surgery centers
  • Hospital Privileges
  • IPA Affiliations
  • Hospitals
Medical Credentialing services, Types of Medical practices we cover for medical provider credentialing

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 $ 299 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.

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