Provider Enrollment and Credentialing Services

Physician credentialing and provider enrollment services is a process of enrolment and attestation that a physician is part of a Payer’s network and authorized to provide services to patients who are members in the Payer’s plans. Credentialing verifies that a physician meets standards as determined by the Payer by reviewing such items as the individual’s license, experience, certification, education, training, affiliations, malpractice & adverse clinical occurrences and clinical judgment.

Effective provider credentialing services are the absolute necessity for better performance of the practice. Without proper enrolment, payments can be delayed or refused by the insurance carriers, even if the physician is able to provide services that are competent and medically necessary.

We offer Physician credentialing services, helping Providers achieve better revenues. Our tailor-made provider credentialing services facilitate the payer enrollment process when a Physician:

• Begin the first practice after Med school
• Switching from one physician practice group to another
• Join or become affiliated to new groups or practices
• Adding New Physician to an existing Group
• Want to become enrolled with a new Payer

Our Credentialing Process Involves the Following:

• Collect all the data and documents required for filing credentialing applications from the physicians
• Store the documents centrally on our secure document management systems
• Understand the top payers to which the practice sends claim and initiate contact with the payers
• Apply the payer-specific formats after a due audit
• Timely follow-up with the Payer to track application status
• Obtain the enrollment number from the Payer and communicate the state of the application to the physician
• Periodic updates of the document library for credentialing purposes