Credentialing & Enrollment
Advantages of Our Credentialing and Enrollment Services
By utilizing our meticulous credentialing and enrollment services, you can enjoy the following advantages:
Expedited Credentialing Across Major Payers
- Accelerated credentialing with prominent payers.
Diminished Claim Denials and Enhanced Cash Flow
- Reduction in claim denials leading to improved cash flow.
Increased Patient Referrals from Network
- Enhanced access to patient referrals within the network.
Streamlined Document Management
- Elimination of cumbersome paperwork through our efficient document management system.
Assistance with Complex Application Forms
- Support in completing intricate application forms.
Cost Savings in Credentialing Processes
- Reduced credentialing costs through our global delivery teams.
Timely Application Status Reports
- Regular and prompt updates on the status of your applications
Credentialing:
Physicians and providers are required to undergo a credentialing process, which entails enrolling and attesting within the network of a Payer. This process authorizes them to offer services to patients who are members of the Payer’s plans. Credentialing serves to validate that a physician meets the stipulated standards for delivering clinical care. During this process, the Payer verifies various aspects of the physician’s background, including education, licensure, experience, certifications, affiliations, malpractice history, any adverse clinical incidents, and training.
Failure to undergo credentialing and enrollment with Payers can lead to delays or denials of payments to physicians, resulting in adverse financial impacts on their practices. Our tailored Payer credentialing and enrollment services are designed to assist physicians in various scenarios, such as initiating or joining a new practice, transitioning between physician practice groups, affiliating with new groups or practices, enrolling with new Payers, and maintaining their credentialing status.
OUR CREDENTIALING PROCESS ENCOMPASSES THE FOLLOWING STEPS:
- Gathering all the necessary data and documents required for the credentialing applications from physicians.
- Safely storing these documents within our secure document management systems.
- Establishing communication with the primary Payers the practice interacts with and adhering to their specific application formats after conducting a thorough audit.
- Vigilantly tracking the application status with the Payer through timely follow-ups.
- Obtaining the enrollment number from the Payer and relaying the application’s progress to the physician.
- Periodically updating the document repository to ensure continued compliance with credentialing requirements.
