Credentialing.com is known for providing the best credentialing services across the United States. With a team of highly trained and dedicated Specialists, you can feel confident choosing Credentialing.com as a safe investment for your business.
Credentialing in general is used in various contexts in different fields. In this instance, the term credentialing refers Medical Credentialing or insurance credentialing. Both Medical Credentialing and insurance credentialing are used interchangeably. Physicians and other healthcare practitioners such as a hospital, a counseling office, chiropractor, Dentist, Physical Therapist, Occupational Therapist, an optometrist’s office, Urgent care, Treatment center, Social worker etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.
Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase. During the credentialing phase, an insurance panel will perform primary source verification on a provider to make sure that the provider meets the minimum requirements of the panel. In addition, the panels may access the CAQH to assess the providers' education and employment history.
Once the credentialing phase is complete, the provider’s application will be sent to contracting. At this time, the provider and the practice may be offered an “in-network” contract with the panel. If they are offered a contract, it will usually include the fee schedule and CPT codes for which the provider is eligible to bill.
At Credentialing.com, we use the term credentialing to encompass both credentialing and contracting phases of the credentialing process. The credentialing specialists are trained to navigate both credentialing and contracting to ensure providers are properly on the panels.
In today’s medical marketplace, being able to accept potential patients’ insurance plans is crucial for the success of healthcare practices big and small. Put simply, if potential patients can’t use their insurance plans at your practice—be it a family medical clinic, hospital, a counseling office, chiropractic, dental, Physical Therapist, occupational Therapist, an optometrist’s office, etc.—patients are likely to “vote with their feet” and find a competing provider who will. Unfortunately, medical credentialing can be an unwelcome distraction from providing quality care to patients–but it doesn’t need to be. Credentialing.com also offers Expert Medical Credentialing for Nurses, Doctors and Physicians.
Patients Want to Use their Insurance
About twenty years ago, physicians and healthcare professionals alike still considered medical credentialing (getting in insurance networks) to be optional for building a medical practice. In contract, today it’s become more necessary than ever for providers to be networked with insurance companies. This is partially because more people in the U.S. have health insurance than ever before. And in many ways, those health insurance plans cover more than ever before. One can go to healthcare.gov to read that previously not covered pre-existing conditions are now, by law, necessarily covered. One can also see that insurance plans also have “mental health parity” which means insurance plans cover services provided by mental health counseling and psychiatric practices. One notable way that insurance plans are more limited than in years past in the absence of “out-of-network” benefits. When one has out of network benefits one doesn’t need to choose a provider who is in network. Instead, the patient can select any qualified provider and later file for reimbursement to his/her insurance company. Today, in contrast to years past, very few insurance plans have out-of-network benefits, and then they do (again, very rare), there are significant financial penalties to the patient for choosing an out of network provider. Hence, patients look in network to find a provider—sometimes the first place they look for a doctor or healthcare provider near them is their insurance plans preferred provider list.
Insurance Plans: Covering more Services than Ever
Medical credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include mental health and behavioral health parity, as well as fewer restrictions on pre-existing conditions and the coverage of supplemental services. These services include physical therapy, massage therapy, acupuncture and others. However, the cost of health insurance in the United States has increased accordingly. Persons invest heavily into their health insurance plans, and you better believe when they need healthcare services—be it general medical care, emergency medical care, dental, chiropractic, optometry, or mental health services, or anything—patients desire (even demand) to use their health insurance plans when seeking those healthcare services.
Insurance Panels: Getting Full and Closing
Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.
We are also very familiar with the licensure process of behavioral health providers, including Licensed Professional Counselors (LPC), Licensed Mental Health Counselors (LMHC), Licensed Professional Clinical Counselors (LPCC), Licensed Clinical Professional Counselors (LCPC), Licensed Independent Clinical Social Workers (LICSW), Licensed Clinical Social Workers (LCSW), Licensed Psychologists, Licensed Marriage and Family Therapists (LMFT), and many others. We understand that a designation in one state (such as LPC, LCSW) might not be interpreted as the same level of certification on another state and we can help you navigate the challenges these nomenclature variants can cause.
Every year, we at Credentialing.com provide Medical Credentialing and Provider Enrollment services that help hundreds of healthcare practices (and thousands of providers) across the United States (from New York, to Alaska, To Hawaii) become credentialed with the best 3rd party payers.
Whether your healthcare practice is looking to join the preferred provider network with Blue Cross / Blue Shied or is looking to become paneled with Medicaid, our highly-trained credentialing specialists can help.
For many healthcare providers, credentialing is a constant hassle. We, on the other hand, make credentialing easy.
Our services include:
From small to large, we provide services all/any healthcare companies, including:
Help Getting on Insurance Panels
If you're looking for a medical credentialing service that can take the burden of getting on insurance panels off of your plate, consider us at Credentialing.com. We’ve helped thousands of providers and practices get credentialed and we'd love to talk with you about our trusted and effective credentialing service. Please feel free to call us at: 1-855-664-5154.
Call us today at (855) 664-5154 to learn more!
Recredentialing can be a tedious and difficult process. Insurance companies do not always communicate when you need to re-enroll with them to remain in-network. While the re-enrollment documents are not as complex as initial credentialing applications, in most cases, the consequences of missing a step or not completing a requirement in time for the insurance company can be detrimental to continuing to bill for your services. That's where Recredentialing Management at Credentialing comes in handy!
Every 120 days, healthcare providers who work with insurance payers, are required to re-attest the information in their online CAQH profile. Failing to re-attest on time, or failing to keep the CAQH database up to date can have negative effects on one’s ability to get paid. Recredentialing Subscribers can rest assured that a CAQH re-attestation deadline will not pass unnoticed.
The 'cardinal rule' of working with commercial insurance companies is that your CAQH must be up to date. As you might already know, the information in the CAQH profile is vast and includes easily overlooked items like your current liability insurance policy, your license expiration date, your resume, and more. As a Recredentialing Subscriber, we will update your information anytime upon request, and also alert you when an item in your CAQH has a looming expiration date.
Many contracts with insurance companies remain active for one to three years. When the contract is up for renewal, providers are often required to re-contract with a payer to prevent being disenrolled with the network. This can cost time and money in denied claims. As a Recredentialing Subscriber, we will help you manage your contracts and complete your renewal processes.
Finally, as a Recredentialing Subscriber, we are available for general guidance and advice when you need us. We will act as a general liaison between you and the insurance companies. We’re always just a phone call away!
Primary Source verification is an important step in the credentialing process. It helps healthcare organizations to maintain qualified medical providers, improve quality of care and decrease liability risk.
What is Primary Source Verification?
Primary Source Verification refers to verfiying a health care provider (Typically MDs, DOs, NPs,PAs etc) credentials such as education, training, certification, licensure etc with the Primary source to determine the accuracy and authenticity. Primary source verification generally includes a combination of online verification with the direct source, telephone confirmation and other direct correspondence.
What is the difference between Credentialing & Primary Source Verification?
Credentialing typically refers to insurance credentialing / medical credentialing i.e getting on insurance panels with insurance companies so that you can bill as in-network. Primary Source Verification (Sometimes referred as Primary Source credentialing) is verification of provider credentials directly with primary source.
Why do a health care organization need Primary Source Verification?
Sometimes people tend to use illegal ways of obtaining degree certificates so that they can carry unlawful work without getting caught. Utilizing fake degrees from colleges or universities, fraud work experience certification, fraud license, lying in resumes to get employment are some examples. There were multiple scenarios where some people have provided medical care and performed surgeries despite no real qualifications. This carries a significant liability risk on the health care organization. Due to these reasons many health care organizations make it their policy never to employ a provider or physician without appropriate credentialing via primary source verification.
What are the typical credentials verified through a primary source verification process?
· State medical licenses
· Federal and State DEA certificates
· State Controlled Substance Registration
· Board certifications
· Medical education
· Training programs (Internship, Residency or Fellowship etc)
· OIG, AMA, AOA, ABMS, ABIM
· National Practitioner Data Bank
· Medicaid Sanctions list
· Medicare Opt Out list
· Medicare Preclusion List
· Medical Malpractice loss runs report
· Work History
· Hospital affiliation verification
Hospital Privileging is a process of approving a specific scope of clinical practice and procedures in a hospital based on the providers credentials and training. Hospital privileging and Hospital Credentialing are sometimes used interchangeably.
We provide services to apply for hospital privileges for all providers and Primary source verification for all hospitals / facilities.
Contact us at (855) 664-5154 or email email@example.com today if you have any questions!
If you are venturing into the world of credentialing, then it’s likely that you’ve already spent a considerable amount of time and resources into starting or growing your practice. Making another business investment is probably not what you’d prefer to do at this point, but you know that credentialing is essential to receiving payments from your client base. You’re probably wondering, “How much does credentialing cost?”
The quickest way to know the cost of credentialing, recredentialing, and hospital privileging is to talk to one of our experts. You’re likely looking for the most cost-effective way to get what you need, which is where we come in. At Credentialing.com, our team can give you a price quote and summary of our services within 5 minutes. Each provider has unique needs and we can help you figure out what those are and the best way to meet them.
Get a Quote Within 5 Minutes. We provide discounts if you sign up for medical billing at the same time.
Hiring Credentialing.com is one of the safest investments you can make. We understand which insurance companies operate best for different practices, so no time (or money) gets wasted. Our team knows what the insurance companies expect and need from interested providers.
Once you’ve been credentialed, the return on your investment will arrive almost immediately, now that you can accept the insurance for a wider range of clients that you would have had to turn away otherwise.
Give us a call and let’s talk about your options. We’ll answer any questions or concerns you have about credentialing, no matter where you’re at in the process.
We make recommendations and help you select the insurance companies you want to be networked with. You complete our master survey, and send in applicable documentation.
We obtain all up-to-date insurance applications and complete them on your behalf within five business days of receiving all necessary documentation from you.
We follow up to make sure all applications have been received. We proactively follow up to ensure the enrollment process moves forward effectively and without delays.
We will inform you about all insurance approvals as soon as we receive confirmation. We will send you all applicable information from the insurance panel. You’re now ready to see clients and bill for services!