Find answers to common questions about medical credentialing, payer enrollment, and our services.
Understanding medical credentialing basics
Medical credentialing is the process of verifying and assessing the qualifications of healthcare providers. It involves verifying education, training, licensure, certifications, and work history to ensure providers meet the standards required by healthcare organizations, insurance companies, and regulatory bodies. This process is essential for providers who want to participate in insurance networks and bill for services.
The credentialing timeline varies depending on the payer and provider type. Typically, the process takes between 60-120 days for commercial insurance companies and 90-150 days for Medicare/Medicaid. Our team works diligently to prepare complete applications and follow up regularly to expedite the process whenever possible.
Credentialing is essential for several reasons: (1) It allows providers to participate in insurance networks and bill insurance companies directly. (2) It ensures patient safety by verifying provider qualifications. (3) Many facilities and hospitals require credentialing before granting privileges. (4) It's often required for reimbursement from Medicare, Medicaid, and other payers.
Common documents include: Medical license, DEA registration, board certifications, malpractice insurance certificates, CV/work history, educational transcripts, training certificates, hospital privileges letters, NPI number, and CAQH profile. We provide a detailed checklist tailored to your specific situation during our initial consultation.
Questions about what we do for you
We offer comprehensive credentialing services including initial credentialing, recredentialing, payer enrollment (Medicare, Medicaid, commercial), CAQH management, commercial insurance contracting, privileging assistance, and credentialing audit/cleanup services. We handle the entire process from application preparation to follow-up with payers.
Yes! We work with physicians (MDs, DOs), nurse practitioners, physician assistants, behavioral health professionals, allied health professionals, dentists, and more. Whether you're a solo practitioner or part of a large healthcare system, we have the expertise to handle your credentialing needs.
Absolutely! Recredentialing is essential to maintain your participation status with insurance payers. Most payers require recredentialing every 2-3 years. We monitor your credentialing status and proactively initiate recredentialing before deadlines to avoid any lapse in participation.
We work with all major insurance payers including Medicare, Medicaid, Blue Cross Blue Shield, UnitedHealthcare, Aetna, Cigna, Humana, and many regional and specialty payers. We have relationships with over 50 insurance networks across the country.
Understanding how we work and what it costs
Our process is simple: (1) Contact us for a free consultation. (2) We review your credentials and develop a credentialing strategy. (3) We prepare and submit all applications. (4) We follow up with payers and track progress. (5) Once approved, we notify you and provide all documentation. Throughout the process, we keep you informed with regular status updates.
Our pricing is competitive and transparent. We offer both per-payer pricing and package deals for multiple payers. Contact us for a customized quote based on your specific needs. We believe in providing value through efficient processes that save you time and help you start billing faster.
While we cannot guarantee approval (as each payer makes their own decisions), we have a 98% success rate. We ensure all applications are complete, accurate, and properly documented before submission. If an application is denied, we work to address any issues and resubmit.
We offer audit and cleanup services for providers with expired credentials, gaps in participation, or other credentialing issues. Our team will assess your situation, identify the problems, and develop a plan to restore your credentialing status. Don't let lapsed credentials impact your practice—we're here to help.
Our team is here to help. Schedule a free consultation and we'll answer all your questions about credentialing.
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