Medical Credentialing Services
To effectively bill insurance companies as in-network providers, healthcare professionals—including physicians, hospitals, laboratories, emergency rooms, and urgent care centers—must successfully complete the detailed credentialing process. This complex procedure is managed through specialized medical credentialing services, which streamline the certification process and facilitate access to a broader patient base, ultimately leading to increased revenue.
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Our Medical Credentialing Services
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(347) 502-6465
Who Requires Credentialing Services
- Launching or joining a new practice
- Transitioning to a new practice group
- Becoming part of new groups
- Securing in-network status with new plans
- Need to maintain current credentialing
- CAQH certification
- Re-credentialing
- PECOS registration and ongoing portal management
A Comprehensive Overview of Our Expert-Approved Provider Credentialing Process
Our credentialing process begins with an in-depth survey conducted by our credentialing specialists. This process involves comprehensive interviews with providers, gathering essential data such as license numbers, educational history, demographics, and professional background.
Our medical credentialing services guide providers in strategically choosing insurance partners aligned with their practice goals and license type, while also finalizing insurance panels based on practice location.
Our services streamline the CAQH enrollment process, handling submissions and ongoing management of ProView accounts. We ensure credentials are kept up to date for seamless primary source verification, enabling efficient payer credentialing and enhancing network participation.
While the standard credentialing timeline ranges from 60 to 120 days, our provider credentialing specialists actively work to expedite the process. By maintaining weekly communication with payers, we advocate for the swift review and approval of your applications, ensuring you can begin delivering care as soon as possible.
Once credentialing is finalized, your application moves into the contracting phase. During this stage, we negotiate in-network contracts that include fee schedules and applicable CPT codes. Our team is equipped to address closed panel issues, advocating for your inclusion through effective appeals. With successful credentialing, you can bill directly, often benefiting from enhanced reimbursement rates available to in-network providers.
As the credentialing process concludes, we continue to provide support by helping you secure all required hospital privileges, including admitting, courtesy, and surgical rights.
Our ongoing monitoring guarantees that your credentials stay up-to-date, preventing any lapses in your credentialing status. Our dedicated team carefully tracks expiration dates and conducts thorough daily and weekly reviews to ensure your credentials remain active. With our expertise, you can have peace of mind knowing that your credentialing is managed effectively.
MediBill Health Partners
Benefits of Choosing Our Credentialing and Enrollment Services in New York
- Lower operational expenses, which are often around 30-40%
- Prevents errors that could cause delays in your enrollment
- Provides you the benefit of having experts handle the task
- Enables your staff to focus on billing and collections
- Frees up more time to focus on patient care and growing your practice
- Eliminates excessive paperwork and saves hours of frustration
Complete Provider Credentialing Solutions
Our credentialing team assists physicians in negotiating contracts with insurance payers, establishing the terms of their relationships. Through effective contract negotiations, healthcare providers can obtain advantageous payment rates, clear dispute resolution procedures, quality benchmarks, and ensure inclusion in networks.
We credential providers with commercial insurance payers like Aetna and Humana, which are private health insurers that offer different plans and networks for their members. By credentialing with these companies, providers can access more patients and negotiate better reimbursement rates.
We empower providers to excel beyond their competitors. Our credentialing specialists handle the registration and upkeep of each provider’s profile on the Council for Affordable Quality Healthcare (CAQH) ProView, an online platform that gathers and verifies provider information for credentialing. Utilizing CAQH ProView enables providers to streamline their credentialing process across various health plans.
We assist physicians in obtaining and renewing their hospital privileges, which grant them the rights and responsibilities to practice within a hospital’s facilities. With these privileges, providers can admit and treat patients, utilize hospital resources, and collaborate effectively with other healthcare professionals.
We facilitate the enrollment of providers in Medicare and Medicaid, the largest health insurance programs in the U.S., covering millions of Americans. By joining these programs, providers can broaden their patient base, boost revenue, and meet federal and state regulatory requirements.
Providers utilizing our credentialing services can enroll in the Medicare DMEPOS program, which includes coverage for items like wheelchairs, oxygen equipment, braces, and diabetic supplies. This enrollment enables providers to offer these essential items to Medicare beneficiaries, enhance their quality of care, and secure reimbursements from Medicare.
Our medical insurance credentialing service oversees the entire revalidation and re-credentialing process for physicians with Medicare, Medicaid, and commercial insurers. With MediBill Health Partners handling these tasks seamlessly, providers can ensure their continued eligibility and avoid any potential interruptions or penalties.
Our team of credentialing and privileging specialists conducts audits on reimbursement matters, including underpayments, denials, delays, and payer errors. We also offer accounts receivable (AR) follow-up services to assist providers in recovering outstanding payments from insurers. By addressing these reimbursement challenges and managing AR, providers can enhance their cash flow, decrease bad debt, and streamline their revenue cycle.
Our Credentialing Services Benefit All Kinds of Practitioners
- Physicians
- PAs/NPs
- Physical Therapists
- Chiropractors
- Occupational Therapists
- Registered Nurses
- Clinical Psychologists
- Marriage and Family Therapists
- Hospitals
- And many more
Your Go-To Patner For Credentialing And Enrollment
Let MBHP medical credentialing services experts help you get through the complicated web of payer and insurer requirements today.