Individual Provider Credentialing

Group provider credentialing is the process of getting group practice credentialed with payers. To be an in-network group provider, the group must be contracted with payers. Individual practitioners within the group must meet credentialing criteria and be approved by each payer to be eligible to see patients. One of the biggest benefits to being credentialed as a group is that if one of the group’s providers leaves the practice/group, the credentialed enrollment doesn’t go with them. So, get started with your group credentialing and get your practice up and running.

Expanding your practice or hiring new individual clinicians or providers to work under your group, it is very important to credential individual providers under the group practice before they could start seeing patients. If you are credentialing as an individual under the new group, you will likely need to do a demographic update. Some insurance companies have a specific form they want you to complete, or they want you to go on their provider portal and electronically submit this update. It seems easy but one of the difficult processes of credentialing.

• Provider Credentialing & Enrollment Services

• Individual & Group Provider Credentialing

• Medicare Enrollment for Individual & Group Providers

• Re-Credentialing services

• Group Practices

• Individual Practitioners & Physicians

• Nurse Practitioners

• Physician Assistants

• Behavioral and Mental Health Providers

• Physical, Occupational & Speech Therapists

  
  
  

Applications submission (Medicare, Medicaid, and Commercial payers) 

•         Individual / Group Enrollment

•         Follow-up with submitted applications for expediting the process

•         Adding / Updating Tax ID and Address

•         Adding new providers under a group contract       

Our Credentialing Services includes but are not limited to:

 New provider enrollment (All Payers/Multistate States Credentialing)

•  Medicare

•  Medicaid 

•  Commercial insurance companies (HMOs, PPOs, EAPs, Medicare & Medicaid replacement policies)

•  Individual & Group Contracts

•  Adding providers to an existing group

•  Multistate credentialing

•  Demographics update

•  PECOS/ I&A updates

•  NPI Registration (Type I and type II)

•  CAQH Enrollment, Updates, and New Registration

•  Group & Individual Medicare Revalidation

•  Payer update requests for changes in demographic/provider data

•  ERA & EFT Set-ups

•         Benefits and eligibility verification

•          Charges Entry (demographics & claims)

•          Claims submission

•       Payments Posting through ERAs, EOBs, IVR, Live Calls, and Web portals

•          Denials Management

•          Fixing EDI Rejected Claims

•          Filing/checking services requirement of authorization

•         AR Follow-up on aged claims

•         Filing appeals

•         Weekly and Monthly AR reports/Spreadsheets

Our operational procedures:

•           Claims are submitted within 48 hours of receipt

•           Payments / EOBs are posted as they come in 

•           All denied/rejected claims are fixed within 3 days and resubmitted

•           Quick response time to practices queries

Billing services start upon signing of contractual agreement