Credentialing

As every provider knows, getting credentialed with certain payers can be a nightmare (Hello Medicare!).

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 goes out to 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 1-2 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.

As many providers know, this particular episode tends to represent the rule, not the exception. Providers don’t have the time to jump through all of the hoops that insurance companies are placing in front of them. They want things to be easy so they can focus their time on more important things, like treating their patients. This is where we would come in…

As a billing service company, we would take ownership of the credentialing process up until final approval; which includes filling out all necessary applications, submitting to the appropriate payer, and following up accordingly until the process has been completed.

The following items below are some examples of what would be covered under our credentialing service:

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 Demographic Information

  • 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.

Link A New Provider To An Existing Practice

  • Research and complete what applications are required for a new provider to get linked to an existing practice within a payer’s system.

Comments are closed.