Amidst the advancement of medical technology, healthcare facilities grow exponentially in size and capacity. While largely overlooked, the key to hospitals performing with quality care and professionalism is the rigorous behind-the-scenes work of their medical staff services department (MSSD). Yet with extensive regulatory process changes, MSSDs struggle to juggle larger objectives that improve bottom lines. Because physician credentialing is critical to hospitals’ uninterrupted operations, forward-thinking hospitals outsource physician credentialing to a reliable and professional physician credentialing service provider. However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request.

The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.  Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in your practice – failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies to whom they are subscribed.

Process involved in provider credentialing:

Process involved in provider enrollment:

  • Provider information verification
  • Updating practice’s pay-to address
  • Enrolling for electronic transactions
  • Monitoring process

We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

Our provider credentialing and enrollment services include:

  1. Collection and evaluation of necessary application data with requisite documents and certificates from payers.
  2. Formulate unique credentialing strategy that selects top payers that receive the claims of physicians.
  3. Retain, update and audit the filed application, relying on provider information directly with carriers when needed.
  4. Track and follow-up with insurance carriers regularly to ensure real-time status of the application.
  5. Receive enrollment number from insurance carriers and brief physicians
  6. Complete routine checks of expiration dates for NYS registration and others, to ensure faster re-applications and manage re-credentialing when required.