Provider Credentialing and Enrollment Services

What Exactly Is The Credentialing Process?

• Medical billing credentialing is the process by which all healthcare service providers become enrolled with insurance companies. Only trusted, vetted, and verified insurance companies include healthcare providers in their network of providers to serve their patients.
• Credentialing, also known as primary source verification,” is a time-consuming process in which the insurance company investigates the physician’s background. They confirm the healthcare provider’s education, competencies, and legal right to practice.

Contracting

• A successful credentialing approval is followed by a process known as payer Contracting, which connects the physician to the payer’s network. In most cases, the payer will share standard reimbursement rates as well as traditional plans such as HMO, PPO, WC, and auto insurance.
The credentialing and contracting process takes between 60 and 90 business days.
How To Apply Credentialing And Contracting
• Online Application
• Paper Application
• Letter of Intent

Credentialing & Contracting Steps

• Many Commercial insurances very ease on submitting the Online applications thru web portal. Once the online application is submitted, you will receive a credentialing application from insurance.
• Once the credentialing application is completed and sent, it takes 30-60 business days.
• Once the provider is credentialed, the panel is open, and insurance will send the contract.
• Receive an agreement or contract from insurance. Once an agreement or contract is sent, the complete contracting process takes 45-60 business days.

List Of Specialties Working For Credentialing & Contracting

• Therapist Credentialing (Physical Therapist, Occupational Therapist, and Speech Therapist)
• Nurse Practitioner
• Physician Assistant
• UrgentCare