Our Services

Enrollment and Credentialing Services

Provider credentialing, the process of getting you and your agency affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the therapy services provided.  Therefore, it is important to get enrolled and credentialed with maximum payers so that clients/parents can use their insurance plans in your practice, failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request. Our experienced team of experts can guide your organization through the entire process without you losing sleep or breaking a sweat. 

Whether you are an employee, an independent entrepreneur, or your own practice, one of the hurdles of paying for your services is to be recognized by an insurance company. Most new agencies are shocked at the time it takes to achieve this. Some insurance companies complete certification within 30 days, while others can take up to 180 days.

PROVIDER CREDENTIALING
The process involves the following steps:

  • Application Evaluation. Completing required documentation and identifying exceptions.

  • Primary Source Documentation. Verify practitioner/ facility information from physicians.

  • Data Entry. Capture data, label, and link images to specific providers/ facilities in the payer's database.

  • Outbound Call. Obtain missing documents and updating the payer's database.

  • Follow-up with payers. Follow-up on submitted credentialing requests.

  • Maintenance of Provider Data. Update provider information as per policies and procedures, and CAQH profile.

PROVIDER ENROLLMENT
The process involves the following steps:

  • Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims

  • Updating practice’s Pay-to address. Validate and update the provider's pay-to address or the billing address

  • Enrolling in electronic transactions. Our team can enroll providers for three electronic transactions:

  1. Electronic Data Interchange (EDI)

  2. Electronic Remittance Advice (ERA)

  3. Electronic Fund Transfer (EFT)

  • Monitoring process. A group of highly skilled team members trained to perform research and analysis on the processor functionality gaps.

PROVIDER CREDENTIALING AND ENROLLMENT SERVICES ALLOW YOU TO:

  • Keep your data up-to-date with payers

  • Process faster payments from insurance and get more patient referrals

  • Mitigate revenue leakage

  • Avoid piles of paperwork and filling out application forms

  • Reduce denials and identify provider trends

  • Build relationships with different payers

  • Receive real-time status of credentialing and enrollment transactions

Need more details? Contact us

We are here to assist. Contact us by phone, email or via our social media channels.