Credentialing

Navigating the maze of insurance credentialing and hospital privileging can be challenging;  it’s time consuming, complicated, and at times, stressful.

Credentialing requires cultivating and maintaining dozens of contacts, it takes detail oriented work.   In the medical industry, mistakes can be costly.

Medical Billing is no different.

We make sure you never have to waste a minute of your time tracking down payments, or dealing with processors, fees, and regulations.

You practice medicine…. We’ll do the rest.

Our professional medical billing and credentialing staff has many years of experience.  They know the filing requirements and have the relationships with the right people to get the job done quickly and efficiently.

Let us know how we can help reduce the administrative burden of billing for your practice!

Here are some tasks we routinely perform for our clients:

Enrollment

  • Advise providers on payer options and requirements
  • Gather and assemble all provider documents
  • Obtain all required signatures from providers
  • Complete Statewide Credentialing Application
  • Create CAQH online database
  • Create provider database in Medical Billing Software credentialing software
  • Complete and send all payer applications/contracts
  • Monitor and conduct follow-up on applications and contracts
  • Respond to payer requests for additional information
  • Complete hospital privileging applications (as needed)

Ongoing Tasks

  • Provide participation lists with effective dates
  • Monitor ongoing credentialing status with payers
  • Complete re-credentialing and/or re-validation applications as required
  • Provide quarterly CAQH online updates and revalidation
  • Update all payers with renewed documents such as license to practice, DEA certificates, CLIA certificates,malpractice insurance, service locations, etc.
  • Maintain NPI registry
  • Assist with credentialing-related billing/payment issues
  • Maintain record of payment-related user IDs and passwords
  • Store electronic records of all payer agreements and participation letters
  • Renew hospital privileges (as needed)