Before a provider or organization can bill an insurance carrier, the provider must first be credentialed by the carrier. Credentialing, enrollments and contracting is the first step in the revenue cycle management process.
Credentialing is the verification and assessment process of a provider’s qualifications, and competency based on demonstrated competence. This can be a time-consuming process, and can take up to six months to complete. The reason for the lengthy process is the requirement for submission of extensive background information. Depending on the circumstances, the clinic or organization for which the provider is working may also need to go through credentialing. In the past, each provider had to be individually credentialed with each individual health insurance plan. For some, this is still the case. Many health insurance companies, however, are now using centralized databases like CAQH.
Enrollment is the process of requesting enrollment in a healthcare insurance panel and plan. If you are a provider and you would like to be able to get paid by your patient’s insurance, you will need to be enrolled with the payers. This process requires management of many application documents and will certainly require the applicant to be extremely organized since the process is so document and detail rich.
Once applications are submitted to the payer, the provider’s medical credentials must be submitted. With supporting documentation attached. It is important that the credentials are verified before the practice is accepted by the payer. If all goes well, a contract will be created and signed.
Click here to set up a time with an Enter Credentialing Specialist. After a brief 30 minute (virtual) meeting, you will be up to speed on the process, steps and timeline to get your providers credentialed, enrolled and even contracted with the Payers of your choice.
After our initial consultation, we will gather your information to begin the credentialing process quickly and accurately.
Next, we will discuss the insurance panels you’d like to apply to. We then prepare and submit applications to your preferred insurance companies.
Finally, we will follow up methodically to ensure proper handling of your contract until completion. If necessary, our appeal servicers will fight on your behalf at no charge.
(With years of provider enrollment and credentialing experience, we know what panels are looking for. We stay informed with changes in the industry, so you don't have to.)
We will handle creation, validation, and maintenance of your provider's CAQH profiles. Maintaining your CAQH profile is one of the services included in our credentialing file maintenance plan. Our staff will make sure your documents are kept up to date, make necessary changes as needed, and re-attest your file on a regular basis (once a quarter, per CAQH requirements) to ensure all insurance companies have access to your current credentialing information.
We will work as your advocate with insurance networks to complete the payor enrollment and contracting process for the healthcare providers in your organization. Becoming an "In-Network" provider for health plans often requires completion of lengthy forms and continuous follow up with insurance companies as each insurance panel uses their own set of provider enrollment requirements and applications. All you do is provide the information once and we handle the rest. Our flexibility allows us to work with as little or as many insurance companies as you choose. We offer cost-effective and competitive pricing.
Enter securely stores your providers' documents, credentials, and licensure information.
Keeps staff in compliance with alert notifications before any expiration deadlines.
All client’s providers have access to our software platform to update, review, and retrieve data and documents for all organization providers. Real time access to your credentialing applications cases let you monitor the progress of each application and interact with our team in a secure environment. You'll be able to monitor all activity performed on your behalf and generate status reports and providers rosters at your convenience.
The definitive guide on credentialing and enrollments. What is the difference? Why is it necessary? How to do it perfectly, the first time.