Physician & Provider Credentialing

Why Credentialing Matters

  • Revenue Protection: Prevents claim denials and payment delays.
  • Compliance Assurance: Keeps providers aligned with payer and state requirements.
  • Time Savings: Reduces administrative burden so providers can focus on patient care.
  • Growth Enablement: Ensures timely enrollment of new providers to expand services.

Initial Credentialing & Enrollment

  •  Gather and verify provider documentation (licenses, DEA, NPI, CV, malpractice insurance).
  • Complete payer applications and submissions.
    • Track applications through approval and provide status updates.
  • Coordinate effective dates with payers.

Re-Credentialing & Maintenance

  •  Manage ongoing renewals to keep providers active with networks.
  • Monitor expiring documents and certifications.
  • Update payer files with provider changes (address, tax ID, group affiliation).

CAQH Profile Management

  • Set up and maintain CAQH accounts.
  • Ensure data is current and attested regularly.
  • Streamline payer access to verified provider information.

Medicare & Medicaid Enrollment

  • Process PECOS (Medicare) applications.
  • Complete state Medicaid enrollments.
  • Manage revalidations and compliance

Ongoing Support & Reporting

  • Provide credentialing status reports.
  • Offer continuous monitoring for payer updates or required actions.
  • Act as the point of contact for payer communications.

Next Steps

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