Services - Credentialing
Medical Credentialing and Insurance Credentialing Services – Get on Insurance Panels, Provider Enrollment and Physician Credentialing
Credentialing.com is known for providing the best credentialing services across the United States. With a team of highly trained and dedicated Specialists, you can feel confident choosing Credentialing.com as a safe investment for your business.
What is Medical Credentialing? What is Insurance Credentialing?
Credentialing in general is used in various contexts in different fields. In this instance, the term credentialing refers Medical Credentialing or insurance credentialing. Both Medical Credentialing and insurance credentialing are used interchangeably. Physicians and other healthcare practitioners such as a hospital, a counseling office, chiropractor, Dentist, Physical Therapist, Occupational Therapist, an optometrist’s office, Urgent care, Treatment center, Social worker etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.
Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase. During the credentialing phase, an insurance panel will perform primary source verification on a provider to make sure that the provider meets the minimum requirements of the panel. In addition, the panels may access the CAQH to assess the providers’ education and employment history.Once the credentialing phase is complete, the provider’s application will be sent to contracting. At this time, the provider and the practice may be offered an “in-network” contract with the panel.
- If they are offered a contract, it will usually include the fee schedule and CPT codes for which the provider is eligible to bill. At Credentialing.com, we use the term credentialing to encompass both credentialing and contracting phases of the credentialing process. The credentialing specialists are trained to navigate both credentialing and contracting to ensure providers are properly on the panels.
Why is Medical Credentialing and Insurance Credentialing important?
In today’s medical marketplace, being able to accept potential patients’ insurance plans is crucial for the success of healthcare practices big and small. Put simply, if potential patients can’t use their insurance plans at your practice-be it a family medical clinic, hospital, a counseling office, chiropractic, dental, Physical Therapist, occupational Therapist, an optometrist’s office, etc.-patients are likely to “vote with their feet” and find a competing provider who will. Unfortunately, medical credentialing can be an unwelcome distraction from providing quality care to patients-but it doesn’t need to be. Credentialing.com also offers Expert Medical Credentialing for Nurses, Doctors and Physicians.
Insurance Plans: Covering more Services than Ever
Insurance Panels: Getting Full and Closing
Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.
We are also very familiar with the licensure process of behavioral health providers, including Licensed Professional Counselors (LPC), Licensed Mental Health Counselors (LMHC), Licensed Professional Clinical Counselors (LPCC), Licensed Clinical Professional Counselors (LCPC), Licensed Independent Clinical Social Workers (LICSW), Licensed Clinical Social Workers (LCSW), Licensed Psychologists, Licensed Marriage and Family Therapists (LMFT), and many others. We understand that a designation in one state (such as LPC, LCSW) might not be interpreted as the same level of certification on another state and we can help you navigate the challenges these nomenclature variants can cause.
Every year, we at Credentialing.com provide Medical Credentialing and Provider Enrollment services that help hundreds of healthcare practices (and thousands of providers) across the United States (from New York, to Alaska, To Hawaii) become credentialed with the best 3rd party payers.
Whether your healthcare practice is looking to join the preferred provider network with Blue Cross / Blue Shied or is looking to become paneled with Medicaid, our highly-trained credentialing specialists can help.
For many healthcare providers, credentialing is a constant hassle. We, on the other hand, make credentialing easy.
Our services include
- Individual Provider Enrollment / Medical Credentialing (Getting on Insurance Panels)
- Group Provider Enrollment
- CAQH Completion and Management
- Primary Source Verification
- Hospital Privileging / Medical Staff credentialing
- Recredentialing
- From small to large, we provide services all/any healthcare companies, including:
- Recredentialing
- Solo Practices
- Physicians
- Psychology Counselors
- Dentists
- Physical, Occupational, Speech Therapists
- Group Medical Practices
- Large Medical Centers
What is Medical Credentialing? What is Insurance Credentialing?
Re-attest CAQH profile on Schedule
Every 120 days, healthcare providers who work with insurance payers, are required to re-attest the information in their online CAQH profile. Failing to re-attest on time, or failing to keep the CAQH database up to date can have negative effects on one’s ability to get paid. Recredentialing Subscribers can rest assured that a CAQH re-attestation deadline will not pass unnoticed.
Manage contract renewals
Many contracts with insurance companies remain active for one to three years. When the contract is up for renewal, providers are often required to re-contract with a payer to prevent being disenrolled with the network. This can cost time and money in denied claims. As a Recredentialing Subscriber, we will help you manage your contracts and complete your renewal processes.
Ongoing customer support
Finally, as a Recredentialing Subscriber, we are available for general guidance and advice when you need us. We will act as a general liaison between you and the insurance companies. We’re always just a phone call away!
On Boarding
We make recommendations and help you select the insurance companies you want to be networked with. You complete our master survey, and send in applicable documentation.
Application
We obtain all up-to-date insurance applications and complete them on your behalf within five business days of receiving all necessary documentation from you.
Follow up
We follow up to make sure all applications have been received. We proactively follow up to ensure the enrollment process moves forward effectively and without delays.
Completion
We will inform you about all insurance approvals as soon as receive confirmation. We will send you all applicable information from the insurance panel. You’re now ready to see clients and bill for services!