Let us begin by asking you some simple questions. Why should insurance providers trust you with their money? Why should they refer you to their policyholders? And most importantly, why should the patients come to you instead of going to any other physician?
CREDENTIALS! It is all about the credentials! Only verified, trusted, and credentialed physicians become insurance companies’ in-network providers, securing exclusive benefits and referrals.
Explore the top 10 medical credentialing companies of 2024 and become a trusted partner for insurance payers to collect full and fast reimbursements.
Top 10 Medical Credentialing Companies in the USA
North America dominated the Global Credentialing Software and Services in Healthcare Market with a 39.47% share in 2023. There are close to 1,400 medical billing companies in the USA, and many of them offer professional provider/ physician credentialing services.
However, the best medical credentialing companies are those that deliver a combination of reliability, affordability, technology, and customized services with quick turnarounds.
The following top credentialing companies in 2024 will smoothen your onboarding process for the insurance panel.
MediBill MD
MediBill MD may be a new entrant in the healthcare billing landscape, but it has quickly become one of the best credentialing companies for physicians. Headquartered in Dallas, Texas, MediBill MD opened its doors in 2023, and since then, it has been offering medical credentialing services across 45+ specialties.
The company only charges 2-5% of your monthly collections for its tailored credentialing service. Its experienced team rigorously follows each step of the process, from information gathering to contract negotiation, to ensure its clients join the networks of the nation’s top-ranking insurance payers like Medicare, Medicaid, UnitedHealth, Cigna, and more.
MediBill MD is HIPAA-compliant and ISO-certified. Its medical credentialing team follows all the regulatory standards to safeguard your personal information and assure top quality. You can contact its representatives via call, email, or live chat for your enrollment in insurance networks.
Bikham Healthcare
Bikham Healthcare is a New York-based revenue cycle management (RCM) firm offering a range of medical billing and coding services to over 500 clients in the USA. The company was formed in 2006, and since then, it has expanded to 4 global offices, 150+ employees, and 15+ specialties. Now, it is an established leader in laboratory billing services.
Their medical credentialing services include network research, application filing/ follow-up, appeals for closed networks, information updates, annual credentialing, and maintenance of PECOS and CAQH profiles.
With Bikham Healthcare, you get credentialed by private and government insurance payers in no time. Some of the payers they target include Medicare, Tricare, Aetna, Kaiser Permanente, and Wellcare. You can contact them to inquire about their “fixed price per application”.
Neolytix
Represented by its cute mascot Doctopus, Neolytix offers remote non-clinical support to private healthcare practices and physicians. It positions itself as the No.1 management services organizations (MSO) solutions provider for healthcare organizations.
Neolytix, operating from Chicago, Illinois, excels at medical credentialing and enrollment. It handles information verification, application filing, payer contract negotiation, real-time updates, and re-credentialing on behalf of its clients.
Its advanced provider onboarding portal, inCredibly™, streamlines the enlisting process for large healthcare organizations and offers innovative solutions like secure cloud storage, automatic status updates, expiration alerts, form library, etc.
You can visit their website to request a free quote and explore their physician credentialing services across 16 specialties.
Capline Healthcare Management
Capline Healthcare Management is an A+ rated, accredited business by the Better Business Bureau. Therefore, it is worth mentioning in our top credentialing companies list.
The company was founded in 2016 in Houston, Texas. Since then, it has managed the revenue cycles of more than 650 clients, helping them achieve near-zero denials in the cut-throat healthcare sector.
Capline’s medical credentialing solutions range from Health Maintenance Organization (HMO)/ Preferred Provider Organization (PPO)/ Medicare credentialing to fee negotiation and re-credentialing. And services like demographic updates and insurance portal creation are included in the price.
You can browse their website for more details on their credentialing process or connect with a specialist for a free consultation.
Billing Advantage
Right from the southwestern tip of North Reading, Massachusetts, Billing Advantage delivers medical billing excellence to over 300 clinicians in 22 states. The company was formed in 2004 and employs billers and coders with more than 20 years of experience in the field.
Under the umbrella of medical credentialing, Billing Advantage manages hospital credentialing, insurance credentialing, doctor credentialing, and mental health credentialing. Physicians from various specialties can apply for in-network partnerships with HMOs, PPOs, Medicare, and Medicaid to collect reimbursements for their services.
You can contact Billing Advantage’s customer service representatives to learn more about their provider credentialing service fee and process.
CureMD
CureMD is an award-winning health information systems and services provider in the robust health IT industry. It was incepted in 1997 and maintains its headquarters in the Greater New York Area. Since then, it has served over 30,000 practices with its innovative specialty EHR systems and advanced medical billing solutions.
With a long list of accolades to account for, CureMD is a worthwhile mention in our ‘best medical credentialing companies’ listicle.
Its customized medical credentialing service includes enrollment in government programs, enlisting with commercial insurance companies, essential registrations like NPI registration and creation of CAQH and PECOS profiles, management of licenses/ certifications/ affiliations, and continued support for re-credentialing. Moreover, CureMD claims to reduce the credentialing time from months to weeks.
You can contact their sales time for pricing details or request a demo before hiring them as your credentialing partner.
Practolytics
With a mission to provide high-quality revenue cycle management solutions to a range of healthcare practices at competitive prices, Practolytics is transforming the medical billing sector. It caters to more than 28 specialties and has partnered with over 1,400 active providers to ensure rapid reimbursements for the continuation of quality healthcare.
Along with an array of medical billing and practice management solutions, it offers credentialing services to healthcare providers. The real benefit of choosing Practolytics as your credentialing partner is that it delivers bi-monthly reports on the progress of your application, saving you from unnecessary stress. Moreover, its direct communication with insurance representatives expedites the process as issues causing delays are addressed on time.
You can reach out to the Practolytics team for more details and to kickstart your credentialing process with Medicare, Medicaid, MCOs, or commercial insurance payers.
Physician Practice Specialists
Trusted by Athenahealth and AdvancedMD, Physician Practice Specialists (PPS) is bringing about real change in healthcare consultancy. Unlike other medical billing and coding companies, PPS focuses on medical credentialing, consulting, and start-up services. It is rated the ‘best credentialing company’, and embodying the Floridian spirit, it is 100% US-based.
PPS was formed in 2008 as a provider of medical credentialing, contract negotiation, and start-up consulting services across the country. Since then, it has managed the applications of over 1 million physicians and helped them get credentialed with government and private payers.
As a credentialing specialist, PPS offers an a la carte of credentialing services, ranging from insurance credentialing to hospital enrollment and CAQH credentialing to medical licensing. You can even explore their cutting-edge credentialing software for application completion, submission, and tracking.
However, for pricing and details, you will have to connect with their sales team over a call or email.
PracticeWorx
It seems like the Sunshine State’s specialty is physician credentialing. PracticeWorx is another company from central Florida that focuses solely on medical credentialing. They position themselves as “insurance enrollment and credentialing experts for healthcare providers”. Their services are available nationwide, and some prominent insurance payers that they enlist providers with include Aetna, Blue Shield, MetLife, Coventry, UnitedHealthcare, and Anthem BCBS.
PracticeWorx offers insurance credentialing services to physicians, dentists, allied health professionals, occupational therapists, behavioral health experts, and lab technicians.
Their comprehensive credentialing process includes the verification of documents (licenses, certifications, personal records, resumes, affiliation letters, etc.), management of credentials (demographic updates, courses completed, credits earned, license renewals, etc.), and completion and submission of applications.
You can contact PracticeWorx representatives to get a ‘no obligation’ quote for pricing and start your credentialing journey with them, or download their whitepaper for more details.
PayrHealth
The last company on our ‘best credentialing companies’ list is PayrHealth. It is a payer relationship management firm that offers credentialing and contract negotiation services and manages its clients’ revenue cycles.
The Austin-based company was founded in 1994 with a mission to forge strong relationships between insurance payers and healthcare providers. Today, it boasts a track record of 50,000+ negotiated contracts and nearly $23 billion of net patient revenue for its clients.
Its suite of credentialing services includes commercial and Medicare/Medicaid enrollment, primary source verification, medical credentialing management and monitoring, medical licensing, and hospital privileging.
PayrHealth guarantees that with its first-class credentialing support, clinicians can save 21 days of processing time and nearly $94.5K in revenue. To date, it has submitted over 100,000 applications and re-attested 20,000+ CAQH profiles (per year).
You can browse PayrHealth’s website for case studies and details or request a free consultation for your credentialing needs.
Things to Consider When Choosing a Medical Credentialing Company
With over 1,300 medical billing businesses in the USA and each one offering some kind of physician credentialing solution, finding the best B2B vendor can seem like looking for a needle in a haystack.
However, if you trust our insight and have narrowed down your options to the 10 best medical credentialing companies listed above, pick the one that prioritizes all the 8 factors mentioned below.
Experience and Expertise
When exploring medical credentialing companies, the first thing that you should consider is their staff’s experience and expertise. Ensure that the company employs credentialing experts who have years of experience in the field and can give you names and numbers to prove their medical credentialing background.
Some companies on our list have decades of experience delivering credentialing excellence, while some (despite being emerging companies) have built dedicated credentialing teams with expertise in contract negotiation, licensing, document verification, etc.
So, begin by assessing which specific credentialing service you need and check if the company offers it and has adequate experience and expertise to guarantee proven results.
Technology and Turnaround Time
Using technology for medical credentialing can enable quick turnarounds. By automating the process, medical credentialing companies can save hours of administrative work and reduce the error rate.
Steps like filling out the application forms, emailing targeted insurance payers, document verification, and profile creations can easily be automated using advanced credentialing software. Moreover, these systems have inbuilt alerts to notify companies of the looming expiration dates for providers’ licenses, certifications, and insurance credentialing. Hence, they get a headstart on the re-credentialing process.
The good news is that all the names in our ‘top credentialing companies’ list use some kind of technology for credentialing and can promise quick turnarounds.
Cost and Compliance
Your chosen medical credentialing company should offer industry-compliant services at reasonable rates.
Again, both factors work hand-in-hand because there is no point in paying thousands of dollars to a credentialing company that does not adhere to federal/ state laws and is non-compliant with insurance payers’ rules. Remember, non-compliance is often considered malpractice and can land you in legal battles.
So, look for a vendor that is 100% HIPAA compliant, ISO-certified, and committed to ethical conduct. But most importantly, select a credentialing partner that is easy on the wallet. Credentialing is the first step of RCM. So, you have a long way to go before you start earning money.
Customer Support and Customization
Last, but not least, opt for a company that offers premium quality 24/7 customer support and personalized credentialing solutions tailored to your needs. Your credentialing partner must understand your concerns and provide prompt assistance to resolve them.
Moreover, they should be able to scale their services up or down, depending on your changing requirements. For example, if you are only interested in utilizing their first-time application submission and enrollment service, they should allow you to opt out of credentialing management and re-credentialing.
Medical credentialing companies that deliver superior customer experience through accessible customer support and tailored services become the epitome of trust, reliability, and top quality.
Bottom Line
To shortlist this year’s 10 best medical credentialing companies, we used metrics like pricing, accolades, reviews and ratings, experience, expertise, technology, turnaround times, compliance certifications, customer support, and success rate.
Our top 10 results include decades-old credentialing companies like CureMD, PayrHealth, and Billing Advantage, as well as disruptors like MediBill MD and Neolytix.
We hope our detailed guide will help you choose the right credentialing services provider for your needs and that the partnership will take you a step closer to financial success.
