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Credentialing Services for Physicians and their Enrollment

Credentialing Services for Physicians and their Enrollment

Credentialing Services for Physicians and their enrollment is crucial to support the revenue cycle for a smooth running physician practice. The credential services provider keeps a check on steady referrals from patients and cash flow.

At the present times, healthcare practices recruit a large number of healthcare professionals which is why their credentialing to the whole process of revenue cycle gets even more necessary. In case of inaccurate, incomplete or overdue credentialing, a healthcare practice will have to face a significant drop in the overall reimbursements. The process of credentialing is, in fact, a large one and depends upon the financier, with its requirements which goes on changing with the time.

In general, credentialing needs to be done with preciseness and with accuracy otherwise it could cause a slowdown in the cash flow. Adding to it, it has now become a must for every healthcare practice to develop claims settlement for a given payer, Also, Credentialing Services for Physiciansis time-consuming and tricky and requires proper expertise plus careful handling.  Outsourcing the physician credentialing services reduces the burden of credentialing of any single healthcare practice.

Key features of outsourcing Credentialing services for Physicians

Credentialing services for physicians cover the following aspects:

  1. Precisely Completion of an Application

.In case of faulty application, one might have to face denied or postponed claims.  Typically, a credentialing application inquires about the following aspects:

  • Address of the Practice
  • Fax
  • Phone
  • Information regarding contact
  • Average patient profile
  • Delivered Services
  • Duplicates of your licensure
  • History of service
  • Trouble records of the practice (if any)

In case of omission or errors in any of the above mentioned aspects, delayed provider credentialing will happen for sure

  1. Follow up Application

If you outsource credentialing services, that organization will offer you a follow up to build up relevant plans. It also ensures the acceptance of your application. The process of following up might continue until the approval of the application and a secured participation.

iii. The Council for Affordable Quality Healthcare (CAQH) Profile

The re-attesting of the Council for Affordable Quality Healthcare (CAQH) profiles is also required for every new license, updated insurance or DEA document.

Credentialing services for physician comprises of the following services:

  • Registration of CAQH

CAQH is basically an online portal to keep the record of supplier information in a protected, associated database.  This protected information is provided to health insurance firms all through the credentialing process to construct obtaining up-to-the-minute supplier information in a well-organized manner.  Implementing CAQH is a requirement for the process of insurance enrollment in many of the states.

CAQH registration is needed within every 3 months for every healthcare practice. An incomplete or inaccurate application to register for CAQH can turn out to be a delay in credentialing. Therefore, outsourcing can be a better resource here.

  • Commercial Insurance Provider Enrollment and Credentialing

The process of provider enrollment undertakes the making of a request for enrollment with a plan; fulfilling the application for enrollment plans; submitting duplicates of licenses, making a contract, insurance, and any other steps that may be exclusive to a delivery service.  A number of commercial carriers make use of CAQH to acquire information regarding credentialing from a central area, and needs that suppliers keep a complete and up to the minute profile in the CAQH system as part of the process of the enrollment.

  • PECOS: The Provider Enrollment, Chain, and Ownership System (PECOS) is an online Medicare staffing scheme which allows the provider and trader to:
  • Submit applications for Medicare enrollment
  • Analyze and print information regarding enrollment
  • Update information regarding enrollment
  • Complete the process of revalidation of enrollment
  • Drop out from the Medicare Program of your own accord
  • Monitor the application status submitted for a Medicare enrollment

Outsourcing credentialing services for physicians do all the hassle for you with great efficiency and precision.

Medicare and Medicaid Provider Enrollment and Credentialing: The Centers for Medicare & Medicaid Services (CMS) make it a compulsion for every healthcare practice to go for revalidation of the Medicare. Suppliers who remain unable to meet the deadline to revalidate Medicare fail to meet the CMS criteria.

  • Medicare and Medicaid Revalidation:
  • NPI Registration:

The National Provider Identifier NPI is an exclusive number to identify covered physicians. The NPIs is a necessary element to incorporate in the directorial and economic transactions accepted under HIPAA. Outsourcing credentialing services carry out the NPI registration for you to smooth the process.

  • Reimbursement Issues:

Outsourcing credentialing services for physicians also resolve reimbursement issues which increase the cash flow by reducing denied claims.

  • Managed Care Contracting Issues

Outsourcing credentialing services negotiate managed care contracting issues.

Hospital Privileges and Reappointments

Hospital privileges are physician’s right through which they can use the facilities and tools of a hospital. By having hospital privileges, physicians can use any operating room. Not every physician keeps hold on the Hospital privileges. In order to acquire Hospital Privileges, the credentials of physicians need to be entirely reviewed. Outsourcing credentialing services aids in achieving hospital privileges.

  • DEA Registration & Tracking

The Drug Enforcement Administration, United States assigns a DEA number to a health care provider on the basis of which he/she is allowed to write the controlled substance as a prescription. Despite the fact that there is no law to prevent its use as a common prescriber detection number, the DEA applies the DEA registration numbers only be used for certifying and keep a record of prescriptions for controlled substances for security purposes.

  • Medical License Application Processing and Monitoring:

Having a medical license for every healthcare practice and a physician is very important to lawfully practice medicine. The process of acquiring a medical license can be time-consuming and exigent. They are not provided to the physicians automatically. All the physicians need to fill an application to obtain a medical license which is a complex procedure. Moreover, medical also requires verification. Outsourcing credentialing services make the entire process hassle-free for your practice.

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