Provider Enrollment and Credentialing Services
Insurance credentialing services help to enhance the entire process of revenue cycle management. An efficient and streamlined workflow will lead to lesser claim denials and an improved patient experience.
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
Our Services
We serve all your needs under one roof
Eligibility and Benefits Verification
Eligibility verification is the process of verifying a patient;s insurance in terms of Validity (Active/Inactive), coverage of benefits
Referrals and Prior Authorization
Our team is knowledgeable in each and every aspect of health insurance, healthcare terminologies and medical/surgical procedures, our verification specialists work with payers as well as patients
Provider Enrollment and Credentialing
Insurance credentialing services help to enhance the entire process of revenue cycle management. An efficient and streamlined workflow will lead to lesser claim denials and an improved patient experience.
Clinical/Utilization Reviews
We prepare concise clinical reviews of the patients by viewing EMR and including the abnormal findings of the patient to be sent to the facility for approval from converting OBS and ER patients to Inpatient
Medical Records Abstraction
Medical Record Abstraction services deliver fast, accurate abstraction of clinical data components that document the provision of compliant care for HEDIS® reporting, and other quality measurement needs. This service creates a base medical record for a patient by going through all the patient’s old medical charts.
Remote scribing
“Spend More Quality Time With Patients, Not Entering Data” Electronicmedical records (EMRs) improve efficiency and make medical information easier to share with patients, providers, and payors. However, all of that data entry takes time away from patients and adds time to a provider’s busy schedule. Our highly trained, remote medical scribes can help.