Patients who are covered by the Payer's plans can only be treated by doctors and other professionals who have obtained the necessary credentials. They must attest to it and join the Payer's network in order to achieve this. The credentialing process ensures that a physician satisfies clinical care criteria by verifying a physician's education, license, experience, certifications, affiliations, malpractice, any bad clinical occurrences, and training with the Payer.
They have the right to withhold or deny payments to physicians who are not enrolled with them or certified by them. These affect the practice's financial status. The following are some advantages for doctors using our specialized Payer enrollment and credentialing services:
- Start or continue a new Practice
- Changing between various medical groups
- Join new organizations or practices and accept membership
- Add additional insurances
- Continue to provide certification services
Our Credentialing process involves the following:
- Compile all the data and supporting materials from physicians needed to submit credentialing applications
- Using our secure document management solutions, the records will be preserved in a single location
- Identify the top payers to whom the practice makes claims and make contact with them
- After a thorough audit, use the forms applicable to the payer
- Continually check in with the Payer to find out how the application is coming along
- Ask the Payer for the enrollment number and inform the physician of the status of the application
- Regular changes to the document library for certification criteria
New Registrations/Renewals of an Individual Provider
- With the State
- With the Drug Enforcement Agency (DEA)
Provider Data Maintenance: Payer System Update Management
- Updated provider demographic information for payers. (Updates to the provider's area of expertise or new educational credentials)
- Upkeep of the provider directory on payer websites. (Checking payer website and confirming provider information, including Phone and Fax numbers and Zip code. updating payers about the correction)
- Enrollments in EFT/ERA
Contracting Creation and Maintenance
- Contracts for new group/individual practitioners
- Including or excluding service providers from the existing contract
- Changing the contract's location by adding or removing it
- Changing the present contract's plan types (Line of Business) by adding or removing them
- Rate Bargaining
CAQH Attestation
The Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative procedures between health insurers and providers for activities such as credentialing, directory maintenance, benefit coordination, and other duties.
- Filing a CAQH application
- Quarterly CAQH attestations
Expiration and Renewals
The State DEA license, Board certificate, and malpractice insurance tracking expiration date
Tracking and Analytics
- Maintaining a record of a provider's credentials paperwork
- Keeping agreements current
- To begin the procedures, maintain track of the dates for expiration, notifying, and credentialing.
- Working together with the rejections team to ascertain whether any claim denials are caused by credentialing issues
The Benefits of Using Our Credentialing and Enrollment Services
Using our complete certification and enrollment services has the following benefits:
- Get certified with all important payers as soon as possible.
- Reduce claim denials while increasing cash flow
- More patients should be referred via the network.
- Using our document management solution can help you avoid having tonnes of papers.
- When completing extensive application paperwork, seek assistance.
- Our global delivery teams enable us to reduce certification costs.
- Find out the most recent status of your applications.
Patients who are covered by the Payer's plans can only be treated by doctors and other professionals who have obtained the necessary credentials. They must attest to it and join the Payer's network in order to achieve this. The credentialing process ensures that a physician satisfies clinical care criteria by verifying a physician's education, license, experience, certifications, affiliations, malpractice, any bad clinical occurrences, and training with the Payer.
They have the right to withhold or deny payments to physicians who are not enrolled with them or certified by them. These affect the practice's financial status. The following are some advantages for doctors using our specialized Payer enrollment and credentialing services:
- Start or continue a new Practice.
- Changing between various medical groups.
- Join new organizations or practices and accept membership.
- Add additional insurance.
- Continue to provide certification services.
Our Credentialing process involves the following:
- Compile all the data and supporting materials from physicians needed to submit credentialing applications.
- Using our secure document management solutions, the records will be preserved in a single location.
- Identify the top payers to whom the practice makes claims and make contact with them.
- After a thorough audit, use the forms applicable to the payer.
- Continually check in with the Payer to find out how the application is coming along.
- Ask the Payer for the enrollment number and inform the physician of the status of the application.
- Regular changes to the document library for certification criteria
New Registrations/Renewals of an Individual Provider
- With the State
- With the Drug Enforcement Agency (DEA)
"Provider Data Maintenance: Payer System Update Management
- Updated provider demographic information for payers. (Updates to the provider's area of expertise or new educational credentials)
- Upkeep of the provider directory on payer websites. (Checking payer website and confirming provider information, including Phone and Fax numbers and Zip code. updating payers about the correction)
- Enrollments in EFT/ERA
Contracting Creation and Maintenance
- Contracts for new group/individual practitioners
- Including or excluding service providers from the existing contract
- Changing the contract's location by adding or removing it
- Changing the present contract's plan types (Line of Business) by adding or removing them
- Rate Bargaining
CAQH Attestation
The Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative procedures between health insurers and providers for activities such as credentialing, directory maintenance, benefits coordination, and other duties.
- filing a CAQH application
- Quarterly CAQH attestations
