Results Driven Medical Credentialing Company
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
Comprehensive Provider Credentialing Services
Are you looking for an ultimate medical coding solution to help your healthcare practice become profitable with timely reimbursements? If yes, you have come to the right place!
We have mastered the medical credentialing workflow to help healthcare providers and facilities become a part of the payer network. Credentialed and in-network providers get regular referrals and are able to collect reimbursements on time following the provider-payer agreement. Consistent cash flow streamlines the practice’s revenue cycle and boosts its financial performance.
Without proper credentialing and verification of your qualifications, you are ineligible to provide care services to insured patients or bill the insurance companies. Here's a look into our tailored services:
Provider Enrollment & Credentialing
Our provider enrollment and credentialing services help providers get registered with various payers, making them eligible to deliver care services to insured members. It involves submitting necessary documentation, verification, and maintaining active provider status with the insurance companies.
Clearinghouse Enrollments
By enrolling our clients in the clearinghouses, we ensure that every medical claim they file electronically is error-free and every electronic payment they receive is timely. We manage the EDI, EFT, and ERA enrollments, enabling a seamless exchange of digital data between the provider and payer.
Insurance Credentialing Services
Our insurance credentialing services are designed to help all types of healthcare providers, including nurse practitioners (NPs), physician assistants (PAs), dentists, pathologists, and radiologists, enlist with insurance panels. We handle their qualification verification, application submission, and contract execution to ensure quick and smooth credentialing and enrollment.
Hospital Credentialing Services
Our comprehensive hospital credentialing services are best for healthcare professionals who seek to provide their services at a hospital. A medical credentialing specialist handles the healthcare provider's application and documentation submission to the hospital’s executive committee to expedite their employment at the hospital.
PECOS & CAQH Credentialing
Under this medical credentialing service, our expert team maintains and updates physician’s Council for Affordable Quality Healthcare (CAQH) and Provider, Enrollment, Chain, and Ownership System (PECOS) profiles. It ensures that the insurance company can access the provider’s accurate information to speed up the credentialing process.
Healthcare Licensing Services
This medical credentialing service caters to new and established healthcare professionals having trouble obtaining and renewing medical licenses to continue their practice in a specific jurisdiction or state. We ensure that the healthcare providers meet the state-specific requirements and pass the eligibility criteria for providing care services to patients.
Payer Contract Management
Payer contract management is another tedious task that can exhaust a practice’s resources while managing it in-house. However, when professionals/practices partner with our insurance credentialing specialists, they can rest assured that we will negotiate payer contract terms for optimized reimbursement rates by leveraging our industry expertise.
Re-Credentialing Services
Our medical credentialing team stays current on all the regulatory and industry changes. As a result, we proactively monitor and manage the requirements for our clients’ re-credentialing and re-enrollment to ensure compliance with the latest regulatory standards set by the insurance payers.
Outsource Medical Credentialing Services to MediBill MD
Are you unsure about outsourcing medical credentialing services? Do you worry that it will break the bank or compromise your personal information? If yes, it is time to debunk your doubt!
Outsourcing medical credentialing services reduces the documentation burden and costs associated with the process. By outsourcing to a reputable medical credentialing company, you can leverage our direct communication with the insurance representatives to streamline the process, ensure enrollment, execute contracts, and become an in-network provider in no time.
Explore the MediBill MD difference by outsourcing medical credentialing services to us.
At MediBill MD, we operate on the ethos of efficiency, compliance, and transparency. We use an advanced project management tool for centralized communication. It helps us streamline our credentialing workflow, and its password-protected interface keeps our clients’ information safe from unwarranted breaches.
We assign an account manager to each of our valued clients to ensure effective communication throughout the medical credentialing and enrollment processes. They are resolved to improve client satisfaction and readily provide personalized assistance to manage intricate situations. Their dedication is aimed toward the efficient completion of credentialing requests.
Hiring, training, and retaining medical credentialing staff is expensive. Besides, if our clients decide to handle this process in-house, they will be required to invest in costly infrastructure and extra space to equip and house the credentialing team. However, when they outsource medical credentialing, we handle it all for them.
Registering healthcare providers for the CAQH and PECOS databases and updating physician records are ongoing tasks. When clients get our professional medical credentialing services, we handle the registration and updates to ensure their accurate information is accessible by all health insurance payers for timely verification and credentialing.
To ensure transparency, account managers schedule bi-weekly calls with the clients and update them on their credentialing status with all the payers. They diligently track the progress of credentialing applications and maintain detailed reports that are emailed to the clients upon request. These updates aid informed decision-making.
Our Medical Credentialing Process
Every step of our medical credentialing process is designed to fast-track your applications and reduce the processing time to under 120 days. With stringent checks along the way, like information verification, regulatory compliance, and licensure review, we prevent the process from derailing and obstructing your path to financial success.
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1. CAQH Profile Login Analysis
After taking healthcare providers on board, we procure their CAQH login credentials and audit the profile for missing or outdated information. If the profile requires an update, we make the necessary changes. However, if the provider does not have a CAQH number, we create a new profile on CAQH ProView.
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2. Data/Document Collection
Next, we create an enrollment file for data consolidation. We upload our client’s documents and save information on a shared location dedicated to medical credentialing. All our files are password-protected and end-to-end encrypted to ensure compliance with the HIPAA data security rule, helping us safeguard our client’s personal information.
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3. Project Management
We utilize our project management tool to create a separate project for each credentialing case. Relevant tasks are added and assigned to the most suitable people for the job, and throughout the process, the tool acts as a cloud storage and progress tracker for information and updates.
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4. Application Submission
Without wasting time, we initiate the medical credentialing and enrollment process with all the targeted insurance payers. We gather all the required information and documents from the healthcare provider and contact the insurance payer for an initial application to their network.
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5. Follow-Ups
Our work does not end with sending initial requests. We keep track of the credentialing process by constantly communicating with the insurance payers. We also provide regular updates to healthcare providers on their application status. At this stage, if the payer requests more information or documents, we get right to it.
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6. Contract Execution
Once credentialed, we follow through with the insurance payers to ensure a contract is signed and uploaded to the payer’s system. A copy of the executed contract stays on our project management tool for easy, 24/7 access. We readily step in if our client seeks assistance in negotiating reimbursement rates.
We Are Available Nationwide
We may be Texans at heart, but that does not stop us from following the credentialing rules and regulations of your state. From the East Coast to the West Coast and the northern point to the southern tip, we offer reliable medical credentialing services nationwide. Our medical credentialing specialists are well-versed in various state and payer requirements, helping you get a spot on your desired insurance panel.
Whether you are a nephrologist, neurologist, cardiologist, or dermatologist, at MediBill MD, we have certified provider credentialing specialists for each specialty. They understand the insurance payers’ credentialing and enrollment requirements for your specialization and guide you effectively to streamline the process.
Also, it does not matter which time zone you are in because our credentialing experts are available round the clock to assist you.
Lowest Prices Guaranteed
Do you want to hire professionals for medical credentialing BUT on a budget? We at MediBill MD offer our provider enrollment and credentialing services at affordable rates to empower providers across the US.
Our results speak for ourselves! MediBill MD is a well-trusted name in the industry. Our healthcare billing specialists optimize the revenue cycle of over 300 verified practices.
Get In Touch with a Medical Credentialing Specialist
Want to know more about our medical credentialing services? Get in touch with us. Our medical credentialing specialist will assess your needs and offer a tailored solution to streamline the process.
FAQs
Primary source verification (PSV) can be defined as the process by which an insurance company or healthcare facility verifies or checks an individual physician's reported qualifications and credentials. It enhances patient safety and ensures that the physician under scrutiny is qualified to render quality healthcare. It also saves healthcare facilities and insurance payers from negligent credentialing lawsuits.
Credentialing is an integral step that endorses medical assistants for their competence and makes them legally eligible to practice. Moreover, it helps them in career advancement.
Provider credentialing and enrollment are interrelated but two different procedures. Credentialing focuses on verifying a physician's competence and qualifications. Contrarily, enrollment helps establish a physician's eligibility to bill a specific insurance company.
If a new provider joins your practice, you can bill for the yet-to-be credentialed physician under the supervising provider’s national provider identifier (NPI). However, there are some things to consider. First, find out if your payer contract allows you to bill under the ‘incident-to’ claims. Second, you must know what types of providers can bill under this category. Last, check if your practice is eligible to provide ‘incident-to’ services.
It is possible in some cases. For example, it is allowed if a provider’s credentialing is in process and he/she sees a patient under the supervision of a credentialed physician. Otherwise, we don't recommend it.
Physician credentialing ensures the healthcare provider is qualified to provide care services and perform procedures. It protects the provider and healthcare facility from liability in case of malpractice or negligence.
It involves verification of a physician's educational certificates, professional records, experience, skills, and training to ensure the provider is qualified to practice.
All physicians must apply for re-credentialing annually or after every two or three years.
No, a non-credentialed provider cannot bill Medicare.
You are only required to provide your Drug Enforcement Administration (DEA) registration information for Medicare credentialing if you prescribe and administer controlled substances. Otherwise, you can check the box ‘Not Applicable’ on the enrollment application form. However, it is best that you register for a DEA license as many medical procedures require the prescription, dispensation, and administration of controlled substances.
It is a medical credentialing service that involves verifying the healthcare provider’s qualifications and expertise and seeking the privilege to practice within a hospital setting.
Hospital credentialing can take between 90 and 120 days.
Insurance credentialing is a broader term that involves various healthcare providers’ qualification verification by insurance payers. It is the first step of the revenue cycle and ensures that the credentialed provider can bill the insurance company for providing care to their insured members.
If you want to enroll with an insurance company, review their medical credentialing requirements and submit the required documents with the application form. You must also provide additional information that they ask for and follow up with them on your credentialing status.
The status codes assigned to HCPCS by CMS identify whether a particular code is eligible for separate payment, bundled into another service, or not eligible for separate payment by Medicare.
