As a practice owner, you might have a team of professional physicians who possess the right qualification and licenses but without properly credentialed providers you invite the risk of losing payments. To enhance the performance of your practice you must complete the entire credentialing process including collecting provider documentation & validation; identifying top payers; applying for top payer; follow-up on the application; obtaining enrollment, and periodic updates of payer documents for credentialing. If you lack the know-how to navigate the physician credentialing process, you need to outsource provider credentialing and enrollment services to professionals like us.
Our Provider Credentialing Services
Our credentialing experts have a deep understanding of payer enrollment guidelines and credentialing policies. Based on your geographical area of practice and patient mix, we identify top payers which need to get credentialed. Whether you own a group practice or are a solo provider, we have a customized credentialing service. For a single-payer our provider credentialing services include the following:
- CAQH attestation includes CAQH application filing; and CAQH quarterly attestations. In case you don’t have a CAQH account created, we will ask for all required information and documentation and will create a CAQH account. We will also enable it for payer review in case of credentialing and enrollment process.
- Filling up applications for all top payers. It will include completing required documentation and identifying exceptions. Verifying practitioner/ facility information from physicians and obtaining missing documents and updating the payer’s database.
- Enrollment for electronic transactions. Our team will enroll providers for electronic transactions like Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA), and Electronic Fund Transfer (EFT).
- Provider data maintenance includes provider demographic updates in payers’ records i.e., updates of provider’s specialty or additional educational qualifications, checking payer website and verifying provider details like Phone and Fax #, Zip code, updating the correction to payers, and tracking expiry date for State DEA License, Board certificate, and Malpractice Insurance.
- Contracting includes new group/individual practitioner contracts, adding/deleting providers in the existing contract, and rate negotiations.
Outsourcing Medical Credentialing Reduces Costs Significantly
Managing credentialing operations in-house could be costly activity as you need full-time experts from various fields. Once you get credentialed with major payers, it doesn’t make any sense to maintain these resources full time only for updating provider details. Although the credentialing process can be expensive and complex, your organization can reduce the time and resources it devotes to credentialing by outsourcing your medical credentialing. Instead of dedicating staff to perform credentialing in-house, an outside organization can perform these tasks for you, allowing you to commit your time, staff, and resources to provide quality patient care.
You can outsource medical credentialing by hiring an outside Credentials Verification Organization (CVO) to perform primary source verification on all your providers, so you’ll know your provider’s credentials are valid and in good standing. This can help you avoid mistakes, relieve backlogs, and speed up reimbursements.
MedicalBillersandCoders (MBC) is a leading revenue cycle company providing complete medical billing services. We are known for providing quick and reliable credentialing services for healthcare organizations of all sizes. To know how our credentialing and enrollment services can assist in increasing your practice collections, contact us at firstname.lastname@example.org/ 888-357-3226