Provider Enrollment and Credentialing
Ensuring that your providers are properly enrolled and credentialed is crucial to maintaining compliance with regulations. Our team can help you streamline the process and ensure that your providers are up to date.
Provider credentialing, or the process of gaining a physician or a service provider that is affiliated with payers, is a crucial stage in your revenue stream. It allows patients to use your insurance plans to purchase the medical services used and also allows the provider to receive reimbursement for the services they provide
It is therefore crucial for healthcare professionals to be registered and credentialed by the top payers to allow patients to utilize their insurance plans within your clinic. Failure to do this could cause the patient to look for a different provider who is affiliated with the health insurance providers they have a contract with.
But the procedure of getting a healthcare provider accredited by a particular payer takes many manual tasks when it comes to filling out the application forms, giving clarifications to queries from payers, and coordinating with them in order to complete the request for credentialing. Trust Access Healthcare to get your credentialed quickly in the manner we know the requirements of every payer and the policies they have in place.
Provider Credentialing
The process includes some steps like:
- Application Evaluation. Complete the required documentation and identifying any exceptions.
- Primary Documentation Source. Verify practitioner/ facility details from physicians.
- Outside Call Center. Obtain missing documents and update the database of the payer.
- Follow-up with the payers. Follow-up on submitted request for credentialing.
- Data Entry. Label, capture images, and connect them to specific facilities/providers within the payer’s database.
- Maintenance of Provider Data. Update information about providers as per guidelines and procedures, as well as the CAHQ profile.
Provider Enrollment
Our Provider Enrollment Services allow methods to enroll in the services they offer by ensuring that the payers have the necessary information to process claims related to the services you offer. We monitor all applicants to ensure that they receive and process applications within the timeframes required. We are diligent in identifying and fixing any potential administrative issues prior to them impacting the reimbursements from your provider.
The procedure includes the steps listed below:
- Verification of the information provided by the provider. Contact payers to confirm that they are using the right information about their provider in their file prior to submitting claims
- Update the practice’s Pay-to address. Validate and correct the practice’s address for payment or billing address.
- Participation in electronic transaction enrollment. Our team can enroll providers in four different types that use electronic transactions:
- Electronic Data Interchange (EDI)
Electronic Remittance Advice (ERA)
Electronic Fund Transfer (EFT) and
CSI - Monitor method. A group of experts in the field is trained to conduct studies and analyses on potential weaknesses in the functionality of processors.
PROVIDER CREDENTIALING AND ENROLLMENT SERVICES ALLOW YOU TO:
- Keep your records up-to-date with the payers
- Pay faster from insurance and obtain more referrals from patients
- Eliminate revenue loss
- Do not pile paperwork up and apply for forms.
- Reduce denials, and identify patterns in the provider
- Establish relationships with various payors.
- Check the status of your credentialing in real-time or through enrollment processes.