Credentialing NEWs:

Credentialing is the first step to receiving timely and proper reimbursement. An approved, credentialed provider is a must-have for all healthcare provider(s)/group(s). Patients are more likely to see a participating provider than a non-participating provider.

We understand how credentialing is an administrative burden for all clinics. Utilizing our credentialing service will eliminate delays and wasted time. Our credentialing specialists are highly organized, experienced, and knowledgeable. We offer full-service credentialing of all payer types and work with all medical and physician groups to gather, process, and track your enrollment forms and progress. We simplify the laborsome process by requesting only the necessary information in an all-inclusive manner. We then verify the accuracy of information. All practitioners will be enrolled along with the clinic group and linked, if necessary as part of the enrollment. We will pick up where you left off in the process or start the process before your clinic opens. Contracts are obtained for your approval and all documentation and forms are supplied to the payer for processing. As part of our credentialing service, progress is supplied to you as made and/or requested.

Revalidations and/or Recredentialing
Revalidation and recredentialing is a requirement by each payer. Medicare requires this every five years and most commercial insurances, every three years. We are well-versed in this area and whether this is the first time you’ve contacted us or not, this is a breeze for our specialists.

Council for Affordable Quality Healthcare (CAQH)
There are many States (Medicaid) and commercial payers that utilize CAQH. Our credentialing specialists will enroll your practitioners with CAQH, manage, and reattest for you.  CAQH requires reattestation every 120 days. We can do this for you. Ask us about our special annual pricing.

Electronic Funds Transfer (EFT)
EFT is a requirement with Medicare. Many State Medicaid payers follow Medicare policy. When we are hired to credential your clinic group, we will setup EFT as part of the service.

National Provider Identifier (NPI)
The NPI is a national provider identifier and used by individual providers (type 1) and healthcare provider organizations (type 2). To manage, apply, or run a simple query, go to: 
https://nppes.cms.hhs.gov/NPPES/Welcome.do.

Insurance Carriers we credential include, but not limited to:
Medicare part B
Medicaid
Aetna
Blue Cross Blue Shield
United Healthcare
Cigna
TriCare
Humana
Railroad Medicare
State Specific Medicaid MCOs & HMOs