Medical Credentialing Services
Managing credentials, re-credentialing, updating provider information, and handling data alterations are crucial tasks for medical offices, yet they can be overwhelming burdens. Spending valuable time on hold and navigating through various insurance company protocols can be both costly and time-consuming.
At Billing Advantage, our team of specialists alleviates the stress and uncertainty associated with completing the credentialing process. By entrusting us with this responsibility, you’re assured of receiving top-quality, current verification through a streamlined process. Whether you operate a medical practice, a hospital, a surgery center, or are a solo practitioner, we tailor our credentialing and provider enrollment services to suit your specific requirements.
Provider Credentialing: What We Can Offer You
Provider credentialing entails verifying the medical qualifications of healthcare professionals to confirm their suitability for delivering patient care. It’s advisable to commence this process when a new staff member joins the team. Numerous healthcare entities, such as Medicare and Medicaid, require credential verification for providers to participate in their network. We can assist you in identifying the most commonly utilized insurance, HMOs, and PPOs in your region.
What is covered under healthcare credentialing?
At Billing Advantage, our credentialing a la carte services cover the following:
- Determining if you are qualified to apply for in-network status with numerous health insurance companies, HMOs and PPOs.
- Access the paperwork needed to apply.
- Fill-out online applications, such as CAQH, and apply to obtain an NPI.
- Follow-up and track your application status while supplying missing information as needed.
- Complete any re-credentialing paperwork as requested by insurance plans.
- Research your geographic area to determine the most common payers to apply to.
- Applications to insurance payers for individual providers or groups
- CAQH maintenance and updating
- Payspan, EFT, and Optumpay setup
- Changes and updates to address, phone numbers, and rosters
- Medicare re-validations
- Hospital Admitting Privileges
- DEA License
- State License
- NPI Creation
- and more
Insurance Credentialing Services
Provider insurance credentialing, also known as insurance credentialing, is indispensable for any modern practice. Without it, your practice would be unable to apply for inclusion in provider panels with insurance companies. This crucial process enables you to bill insurance companies as an in-network provider. Once you meet specific requirements and gain acceptance, you can then submit claims for reimbursement.
Physician Re-Credentialing
Re-credentialing involves regularly reviewing and confirming that your staff’s medical credentials remain current. This procedure validates education and training while also serving as a safeguard against healthcare fraud. In many states, medical providers are required to undergo re-credentialing every two years. Failure to do so may lead to penalties, reimbursement recoupments, and sanctions.
Credentialing Services for Providers You Can Trust
Undoubtedly, medical credentialing and re-credentialing stand out as the most reliable methods for maintaining accurate and current provider information. Moreover, they secure your association with insurance plans, facilitating third-party reimbursement for the care you provide to patients.
To begin, we simply require you to gather and complete some paperwork. Afterward, you can delegate the time-intensive tasks to us. It’s worth noting that medical credentialing is a lengthy endeavor. Depending on the insurance provider, the enrollment process may span up to six months for full completion.
Once you’ve collected your documents and are ready to move forward, connect with our specialists today. For more detailed information, contact us at 1 (800) 518-3375.
