Credentialing & Provider Enrollment

Credentialing & Provider Enrollment

Credentialing and provider enrollment can be one of the most frustrating jobs for individuals who are unfamiliar with the process. Each payer has its own set of guidelines and procedures, and missing just one step in the process can cause weeks or months of delays before you are even notified that you’ve missed that step. Let DoctorsManagement get the job done quickly and efficiently.

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Medical Provider Credentialing Services

At DoctorsManagement, we provide complete physician credentialing services. To ensure we effectively handle every aspect of the process, we analyze your payers for their specialty and geographical location and review their contracts. We assign you a credentialing representative who will be there for you when needed and is easy to communicate with.

DoctorsManagement specializes in Medicare, Medicaid, and all other Commercial/Private Insurances. We provide services for startups and established group practices and various facility entities that have completed the licensing process — including, but not limited to:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Urgent Care Providers/Urgent Care Facilities
  • Audiologists
  • Behavioral Health Providers
  • Physical, Occupational, and Speech Therapists
  • Labs, Ambulatory Surgical Centers (ASCs), and Imaging Facilities

Depending on your specific needs and goals, we offer various services, such as:

  • Group and Individual Provider Enrollment and Credentialing for Commercial Payors
    • New Application Services
    • Application Follow-Up Services
  • Individual and Group Medicare Enrollment
    • New Application Services
    • Application Follow-Up Services
  • Medicaid Program Enrollment for Group and Individual
  • Annual Credentialing Maintenance
    • Medicare & Medicaid revalidation/reverification
    • Demographic updates
    • Commercial Payor revalidation/reverification
  • Re-Credentialing
  • Telemedicine Credentialing
  • Staff Credentialing Training

National Provider Identifier (NPI) enrollment, Council for Affordable Quality Healthcare (CAQH) registration, maintenance, and attestation, and registration with healthcare payor portals such as Humana Military, the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), Availity, and UnitedHealthcare (UHC) Provider.

As part of our provider credentialing and enrollment services, we provide:

Full Credentialing and Enrollment: We can complete all the required Medicare service forms and applications, along with Medicaid services and other third-party payer applications.

Revalidation: We can complete the task of getting the provider(s) and/or group revalidated with Medicare by processing all of the necessary paperwork.

 

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    Dawne Wood

    Credentialing Services

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    Dale Rothenberg

    Credentialing Services

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    Shannon Harrington

    Credentialing Services

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Understanding the Medical Credentialing Process

Medical credentialing is the process of verifying a healthcare provider’s qualifications, including education, training, and licensure, to ensure they meet the standards required for delivering care. It ensures a provider has proper credentials to practice medicine and includes hospital privileges, malpractice insurance, education, board certification, professional references, and additional information.

In order for organizations to attain primary source verification of the practitioner’s education, training, certificates, provider type, and licensure and maintain a file on each provider, they must be given permission to research their background, education, licensure, and professional certifications. Provider enrollment applications are part of the enrollment process and are completed to help determine the medical practice physician’s eligibility.

A physician must be credentialed for their scope of practice, including procedures and special equipment they will use in those procedures.

The overall processing time to credential and contract a new provider can take 3-6 months depending on the payer and state. Credentialing is the first step of the process during which a payer verifies that a provider has the necessary educational & training background and the social & ethical requirements to treat their members. This takes 90-120 days. Once a provider is credentialed, they need to be contracted with the payer to be considered in-network and participating. The contracting step can take 60-90 days.

Here’s what you can expect:

  1. Analyze your specific network needs and determine who the top payers are.
  2. Execute a contract for the work.
  3. Gather necessary documents from the provider
  4. DoctorsManagement team prepares and submits the credentialing application and requests with the outline payors
  5. Obtain contract offers from the outline payors, review and submit acceptable contract offers
  6. Obtain the executed contract and inform the provider of the network effective dates so they can begin scheduling patients for the outlined payor
  7. Inform the provider of the executed documents so they can begin claim submission.

What Are the Benefits of Our Insurance Credentialing Services?

When utilizing an outsourced credentialing company, you want to choose a team that will take ownership of the process as your representative. You should feel like the company thoroughly understands your needs and goals and has the expertise to provide excellent communication and complete transparency. At DoctorsManagement, we can help your business create a full, long-lasting credentialing program.

Trustworthy and reliable doctor credentialing services

We are committed to providing some of the best response times to increase your revenue. Whether you’re starting a new practice or expanding a solo or multi-specialty medical practice, our team moves quickly to get you credentialed with the necessary payers. We also do enrollment for community hospital providers and work with numerous specialties, including dental practices.

Transparent communication and fast response times

Throughout the process, our team will stay in contact with all the necessary details. We do what it takes to prevent setbacks, ranging from missed steps to issues with beneficiaries.

Reduced administrative burdens

You will be better equipped to achieve clinical excellence and patient satisfaction while also meeting financial and operational objectives. Our team facilitates credentialing and enrollment so that you can focus on caring for patients and building your business. You receive bi-weekly updates and a post-credentialing resources book that contains those “hard-to-find” forms for the next time you credential or revalidate. Benefit from our proven system of faster and easier credentialing without delays.

Provider Enrollment and Credentialing FAQs

What is provider enrollment?

Provider enrollment refers to the process in which healthcare professionals register with health insurance plans or insurance networks to become eligible for reimbursement for services provided to their patients.

Q. How long does the credentialing process take?

A standard credentialing process can take 3 to 6 months based on the intricate guidelines. The application and approval process should take about 90-120 business days. There are many complexities in provider credentialing and certain providers will require a longer time to become verified.

Q. Do all credentialing firms have experience credentialing all specialties?

No, but most offer provider enrollment for providers across the United States in a vast array of specialties.

Q. Do all provider enrollment companies check the same information?

Not all agencies check the same information. This depends on the agency and the provider background and history. Some agencies will choose a background check, fingerprinting, national provider identifier information, and other additional information.

Q. What steps are involved in getting credentialed?

  • Identify and assemble required documents and information
  • Prioritize list of insurers
  • Double-check for accurate information
  • Register, complete, and attest provider’s CAQH account
  • Submit requests for credentialing/contracting to outlined insurance payers
  • Follow up to ensure requests have been received and are in process
  • Verify when credentialing/contracting has been completed and obtain provider’s effective date
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Get Credentialing Help With Provider Enrollment

Getting started with credentialing services for providers is easier than ever. Here’s how our process works:

  1. Schedule your free consultation.
  2. Learn how we avoid credentialing delays and denied claims.
  3. Receive a custom quote with payment options that work for you.

Ready to begin? Please get your free quote via contact form or through email at [email protected] today.

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