Streamline your credentialing process

Credentialing, re-credentialing, provider updates, and data changes can be overwhelming for medical offices. We specialize in making the credentialing process simple and stress-free. By outsourcing to us, you can trust that your verification will be accurate and up-to-date.

Our comprehensive services enable healthcare providers to avoid claim delays, save time, and simplify provider enrollment. With our centralized process and expert guidance, you can start generating revenue sooner.

Value of Credentialing Services

The importance of medical credentials cannot be overstated. They not only guarantee the competence of healthcare personnel but also ensure the safety and effectiveness of patient care. By verifying education, training, and licensing, medical credentialing ensures that providers have the necessary skills and knowledge to deliver high-quality treatment. Additionally, it helps reduce liability by confirming that providers meet regulatory and insurance requirements. Ultimately, medical credentialing plays a critical role in improving the quality of healthcare by promoting best practices and industry standards.

What Information is Required for Credentialing?

The information required varies between payers, but generally remains consistent and includes:

NPI Number

CAQH Profile

Practice Information

Medical License

DEA License

License to Practice

License History (Revocations, Suspensions, Censures)

Insurance Information

Education: Degrees and Transcript

Board Certification

Detailed Work History

References (Previous Employers/Practitioners)

Malpractice Claims History

Malpractice Insurance

Insurance Login Details (Medicaid, Medicare)

Frequently Asked Questions (FAQ's)

Aetna, Blue Cross Blue Shield, Cigna, Humana, Medicaid, Medicare, Tricare, TriWest, United HealthCare, and VA are the major payers we work with. If there is a payer you would like to work with that you don’t see on this list, please contact us.

When you decide to outsource your credentialing, it’s crucial to choose a company that offers prompt responses, clear communication, and complete transparency. You need a professional and caring partner who will take full ownership of the process and act as your representative when dealing with insurance companies.

The process is started by assessing your network needs or evaluating top payers in your area. Once decisions are made, a contract is signed and payment is made. Our credentialnig team collects all necessary documents and contacts insurance companies to start the application process. Most companies can complete this process online, but if not, we fill out and send forms as required. We follow up promptly with the payers to ensure receipt of applications. We also keep providers updated throughout the process until enrollment is confirmed and a contract is executed, allowing the provider to start submitting claims.

The amount of time it takes to complete credentialing varies depending on the insurance carrier. Major carriers typically finish the process within 90-120 days. Be aware that smaller carriers and insurance plans may require additional time. 

Enrolling in Medicare can take anywhere from 60-90 days, depending on your state. It’s important to note that the effective date of your Medicare coverage is determined by when your application is received. This means that providers can retroactively bill for any medical services that occurred between your application and approval. Plus, there’s a 30-day grace period that allows providers to bill for services provided up to 30 days before your Medicare coverage begins.

Medicare enrollment revalidation is a requirement every 5 years, with DMEPOS suppliers revalidating every 3 years. For individual providers, there are two options: filling out the CMS855I paper application or using PECOS for online revalidation. Groups or suppliers must complete the CMS855B applications. If an Electronic Funds Transfer was not previously set up for the group, it must be created for the revalidation process.

It is crucial for providers to respond to their Medicare carrier within 60 days of receiving the revalidation letter. Prompt response is necessary to avoid termination of billing privileges.