Credentialing and Enrollments

Insurance Credentialing Services

Be it you doing your private practice or running larger facility of healthcare, the first and foremost imperative step is insurance credentialing in the implementation of your updated revenue cycle. Yet, even when you are aware of the insurance companies with whom you want to participate, it is quite time consuming and often a frustrating process to get credentialed. That is the reason many organizations are outsourcing this crucial step.

CredablePro is up to being your Practice Management Concierge service. We go ahead with handling insurance credentialing for physicians, practitioners, hospitals and a wide variety of other healthcare institutions. From beginning to end, we will take you through each step of getting approval from an insurance payor. This is what you need to learn why unlimited healthcare professionals and organizations put faith in us for medical insurance credentialing services.

Credential Servicing With Insurance Networks

In the present marketplace of healthcare, it has become essential to accept potential patients insurance plans for the success of your practice. Health insurance credentialing is even known as insurance provider credentialing. It is a process used by medical insurance companies for you to apply for inclusion in their provider panels. In case you want to bill an insurance company as an in-network provider, you need to take up the credentialing process.

Initially, the insurance company to which you are applying will verify your coping with the internal requisitions such that you can begin working as an in-network provider on their panel. This could be comprising your education level, training and professional experience.

Once you are done with the credentialing of your practice or organization with an insurance company, you can directly bill the payor. Besides, there are incentives offered by many insurance companies or payors to the Healthcare providers like:

    • Referrals
    • Their inclusion in their web based directories such that consumers are able to locate you as a participating Helathcare provider for your specific specialty.
    • Preferred rates of reimbursement.

With CredablePro, we assist you in getting your applications accomplished doubly faster for Medicare, Medicaid, Aetna, Cigna, United Healthcare, TRICARE and almost any other provider. Mentioned below are a few of the purposes we serve on your behalf throughout the process of credentialing:

Network Research

We assure you that your Group or Practice has the most varied, popular and effective networking payor mix. Our team involved in credentialing is extensively experienced in the enrollment of physicians with Medicare, all Medicaid’s Managed Care plans along with all commercial payors. Our team stretches to every payor shortlisted with whom you want to enroll and gets you accurate timelines along with availability of open panel.

Application Filing

Complete checklist is sent regarding all the information and documents required to file the applications. The moment we have got all the details from you, our team engaged in enrollment takes initiative and files your contract applications appropriately and assures it’s not a flaw submission in the initial go, subject to our extensive experience. Consequently, when we initially submit the correct applications, proudly we get the contract in the shortest turnaround time.

Follow-Up of the Applications

We have a team that regularly follows up on the submitted applications two weekly, ensuring the receipt of the submitted application in the payor’s system and there is no request of any additional information along with everything going smoother. Our team does a regular follow-up until the contract is come through and has reached your physical location.

Appealing for Closed Panels

We assure to send an extensive appeal outlining the key points of your service that includes niche services and details on the way you are bringing the exceptional patient care in your area. These detailed information are all included in your business plan and submitted to senior healthcare provider representatives towards that particular payor. While it can be difficult to overturn the decisions of closed panels, we have a 30% success rate.

Out Of Network Enrollments

This applies to all healthcare providers who opt for staying out of touch with certain payors. Or if it is because of any existing closed panels, are compelled to be out of network. Our team is available to provide assistance with all those out of network enrollments, NPI registrations on the payor’s website etc. so that your medical practice is in the system of the payor to begin receipt of payments from those out of network.

Demographic Changes

We provide assistance with all basic and complex demographic changes like updating of a new TAX ID with all payors in your payor mix, updating a new address, bank account, etc. We also provide assistance in setting up of all ERA and EFT enrollments.

Annual Credentialing Maintenance

It is pivotal to have accurate provider database management for larger healthcare facilities having multiple providers. We are able to do the management and maintenance of all your healthcare providers’ and physicians’ credentialing data on our credentialing portal. We have specifically designed this very comprehensive, transparent and HIPAA compliant tool to ensure we keep up your database utmost with great accuracy and efficiency.

PECOS and CAHQ Set Up and Maintenance

In today’s healthcare environment, keeping up to date PECOS and CAHQ profiles is of utmost necessity. The biggest payors are turning the CAHQ route to credential and enroll medical providers. We do the maintenance and upkeep of all your CAHQ and PECOS profiles, thereby assuring all your information is profiled and compliant in an accurate manner.

Industry Segments

Hospitals

Physician Group Practices

Medical Laboratories

Skilled Nursing Facilities

Ambulatory Surgical Centers

Durable Medical Equipment Providers

Home Health Agencies

Tele Radiology / Telehealth

Which Insurance Companies Should I Credential With?

When considering the insurance companies you need to be credentialed with, you must have a look at the major national plans available.

But you need to know the valuable local insurance companies. For the determination of the same, you must ask a peer or another practice in your area about the local health insurance companies that best cope with the requisitions of your patient base.

When you are engaged with CredablePro, we are extensively doing network research to make sure your practice or group is inclusive of the most variable, renowned and effective insurance providers. We take into consideration various factors that comprise the top payors and your budget. Then we make a follow up with you on this list till you have given us the green light to proceed further.

Private Practice Correlation with Insurance Credentialing

Those into the establishment of a private practice often come across confusion regarding insurance credentialing and procedures for billing third party networks for their services.

The initial step in the set up of your revenue cycle is the application for credentialing and acquisition participating provider contracts with your opted insurance companies. While this can be complex, CredablePro takes the initiative on your behalf. We proffer you with the knowledge base of guidance and industry so that you can set up the revenue cycle for your new practice with ease.

Government Health Programs Relation to Insurance Credentialing

Healthcare provider enrollment and insurance credentialing for government health programs like Medicare, Medicaid and Tricare are diverse a little bit. These programs need you to fill out their standardized forms accurately. Then they must go to the appropriate intermediary who is into handling administrative duties for the program in your jurisdiction.

CredablePro is comprehensible to these stern enrollment standards. This very comprehensive enrollment process is then taken on so that your application is less inclined to denial risks.

Insurance Credentialing Process

If you have keen interest in knowing how to get credentialed with insurance companies, please be careful that this process may take several months, and many insurance companies may not be acceptable to new providers on their panels. That’s why it is worthwhile to outsource this process so involved. We are provisional with extensive research and expertise to professionals and organizations to make sure we follow each payor’s guidelines that include:

  • Required Documents
  • Needed application data based on your type of specialty
  • Whether applications are to be done online or via physical submission.
  • Whether there is a requisition of sending a letter of intent.
  • Follow up on-time, failing which there can be denial if not handled properly

Many insurance companies divide their credentialing process into two – credentialing and contracting.

Credentialing Phase

Here we provide you assistance in the submission of a participating request to your chosen health plans using their specified credentialing application process. Once the health insurance company is in the receipt of your credentialing application, employees begin their verification process. Your file is then gone to the company’s credentialing committee for approval. The whole process takes upwards of 90 days.

While this phase may feel drawn out, CredablePro account manager will be able to proffer you with weekly or even daily real-time application updates.

Contracting Phase

This is the second phase of credentialing. This is when there is an approval of your practice or organization’s application, and you have been given a contract for participation. Many insurance networks split the contracting phase from the credentialing step.

We provide you assistance in the course of credentialing and even help you with contracting negotiations before you sign your agreement, including the following:

  • Reviewing your participating provider contract language.
  • Explanation of the participation responsibilities
  • Ensuring your getting the best probable rates of reimbursement

Once your agreement is signed by you, an effective date and provider number is given. Then you can begin the billing plan and receive your in-network reimbursements.

Credablepro All the Time Available for Credentialing and Enrollment Services

CredablePro has been on vocation since 2005 with healthcare practices and organizations across the U.S., providing impeccable credentialing and enrollment services. If you need any help to complete the credentialing process with insurance companies quite timely, we guarantee your credentialing and contracting to go as picture perfect as probable.

In every facet of the healthcare industry, countless organizations turn to CredablePro because they customize their services of medical billing for fitting their clients’ needs. Starting from consultation to further taking step on your behalf, you can grasp a lot about our services when you come across us online.

Our Enrolled Specialities

Laboratory

Durable Medical Equipment

OBGYN

Urology

Physical Therapy

Cardiology

Orthopaedic

Sleep Medicine

Chiropractic

Internal Medicine

Radiology

Behavioral Health

Anaesthesiology

Surgery

Rehab Billing

Frequently Asked Questions

We try our best to make sure this doesn’t repeat or occur. But suppose there are some unexpected circumstances due to which this has happened, we do maintenance of a regular pursuance with the payor towards provision of real-time information to you and we attempt and expedite the process flow. No matter whatever time it is taking, our team guarantees we get the best available/probable solution.

  • First provider Enrollment (For New Providers)
  • Re-credentialing & Re-validation
  • Relocation and Demographic changes
  • Merger & Acquisition On-boarding
  • Enrollment of Rural Healthcare
  • Management and consulting services of organizational / institutional provider enrollment

Credablepro is an old Revenue Cycle Firm, and it can unconditionally assist in clients credentialing in regard to their backlogged claims and AR. We even proffer RCM consulting, so your internal backend team will be able to handle those difficult denials like experts. There is no need to do replacement of your internal billers. We go ahead to work on your backlogs as a special project and work on a consultancy basis.

When applications are submitted by your team, while entering information, commission of small mistakes can lead to application rejections. At Credablepro, we show familiarity with such rejections and take actions for their timely resolution. Our team reviews every application towards errors rectification followed by resubmission of the same while keeping a regular follow up until the applications are finally accepted and the contract is granted.

The whole cost is dependent upon the kind of requisition that you have. For getting commenced, you can put a request for a quote by having a word with one of our experts. We get you connected to our Enrollment consultant who is specialized in your region and area of practice and will handle your applications from start to finish. Once we have finished with what we want, your part is equally done. We work altogether to get your applications approved and keep you updated at every stage of the way.

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