Credentialing

As every provider knows, getting credentialed with certain payers can be a nightmare!

If a payer is accepting new applicants, then the provider has to figure which applications need to be submitted and where to find them. Sometimes this experience can be easy, but often times it goes something like this:

Provider: Hello, can you please tell me what applications I need to fill out in order to get credentialed with your company?

Customer Service Rep: Sure, just go to our website and look under the Provider Services section.

Provider: Actually, can you just tell me the names of the exact applications I need to send in and show me where I can download them from?

Customer Service Rep: We can’t walk you through the website, but just go to the provider services section, and it will be listed right there.

Provider: Fine, I’ll take a look. Thanks

When a provider navigates through the payer’s website, they soon learn that everything is not as straightforward as the customer service rep made it seem. Instead of calling the payer back and dealing with another “friendly” rep, the provider does their best to figure it out on their own by filling out those applications that they think are required.

Then 2-3 months later, the provider receives a letter in the mail stating that they still need to fill out another application, or the application they did submit was filled out incorrectly…and thus, they need to start the whole process all over again.

How Does it Work?

As a billing service company, we would take ownership of the credentialing process until final approval by performing the following tasks:

  • We would fill out all necessary applications where we can, or we would send the applications to the provider instructing them on which sections they need to fill out.

  • Once a credentialing application has been submitted, we will follow up periodically with the payer to check on the status and to make sure that there are no issues.

  • We will keep the providers informed of the status of their credentialing applications and when they can expect final approval.

What Would Be Covered?

Paneling

  • Follow -up with any payer to see if a provider is eligible for paneling.
  • Research and complete what applications are required to get a provider paneled with a specific payer.

Update Provider Demographics

  • Research and complete what applications are required to update specific provider information within a payer’s system, such as: Name, Address, NPI, Tax ID, etc.


Other

  • Help new providers get linked to an existing practice within a payer’s system.
  • Help providers get setup for EFT (Electronic Funds Transfer).
  • Help providers get registered with a payer’s portal (website) so they can check on a patient’s eligibility, benefits and claims status.
  • Help with any administrative task that an insurance company requires a provider to perform.

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Working on Medial Claim