Credentailing, Provider Contracting

Provider Credentialing Document Checklist: The Essentials

A physician credentialing document checklist is an important tool for organizations to ensure that all required physician credentialing documents are obtained and filed. As the credentialing process involves healthcare organizations, hospitals and insurance networks assessing and confirming the qualifications of a physician or any other healthcare professional.

The following is a list of essential physician credentialing documents:

1) Application for Physician Credentialing

2) Curriculum Vitae or Resume

3) Educational History and Transcripts

4) Current Medical License, DEA Registration and Board Certification

5) Personal Immunization and Health Records

7) Hospital Privileges and Hospital Affiliations Letter(s)

8 ) Letters of Recommendation (both Personal and Professional)

9 ) CAQH Enrollment

10) Evidence of Continued Malpractice Insurance Coverage

The application for physician credentialing is the first step in the process and should include all of the required information about the physician, including name, address, Social Security number, date of birth, etc. The curriculum vitae or resume should list all of the physician’s education and training as well as their professional experience. The educational history and transcripts should be sent directly from the schools attended. The current medical license, DEA registration, and board certification should be kept up to date and on file. The personal immunization and health records should be obtained from the physician’s office. The hospital privileges and hospital affiliations letter(s) should come from the hospital(s) where the physician has privileges. The letters of recommendation (both personal and professional) should be sent directly to the organization from the individuals writing the letters. The CAQH enrollment should be completed by the physician and kept on file. Evidence of continued malpractice insurance coverage should be provided on an annual basis.

Organizations normally require that all of these documents be on file and continuously updated in order to credential a physician. This will ensure that the organization has all of the necessary information to make an informed decision about the physician. Be aware that each insurer may require different or additional documentation and forms. There is a need to submit complete applications to each insurer the provider plans to work with—and even a single missing piece of information can delay approval by weeks or months.

Want to avoid significant delays in your enrollment and credentialing applications? Reach out to us at 855-3676559.

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Credentailing, Provider Contracting

The Benefits of Electronic Provider Enrollment and Credentialing

The days of filling out paper applications and faxing them in are slowly becoming a thing of the past. More and more providers are enrolling and credentialing electronically. There are many benefits to electronic provider enrollment and credentialing. In this blog post, we will discuss the benefits of electronic enrollment and credentialing so that you can make an informed decision about whether or not it is right for your practice!

Among the benefits of electronic provider enrollment and credentialing is that it saves time. Rather than spending hours filling out paper applications, information is entered into an online portal. This can save you a significant amount of time, which you can then use to see more patients or take care of other administrative tasks. By doing this, providers are required right at the beginning of the process to submit a complete set of requirements thus resulting in less rejection or denial of applications. Although it may seem daunting at the start, organizing is the key as we mentioned in another blog.

Another benefit is that it is more secure. Paper applications can be easily misplaced or lost, but electronic applications are much harder to lose or tamper with. This means that your information will be safer and less likely to fall into the wrong hands. Submitting your documents electronically is cost-effective because there is a decrease in the volume of paper needed to submit the requirements and more efficient since it’s a less labor-intensive way of credentialing.

Lastly, it improves the logistics with regard to the dissemination of information and the ability to have documentation of what was used to make a credentialing decision on a specific date. An online application can be immediately available to an applicant/your enrollment and credentialing partner while a mailed paper application won’t be available for several days.

Overall, electronic provider enrollment and credentialing offer many benefits, such as time savings and increased security. Our company offers you a guarantee that your documents are secured and treated with utmost care and confidentiality; that your application is handled only by experts and the best from our team.

Want to know how long it takes for the process to complete? Any other questions or would like more about the services we offer? Reach out to us at 855-3676559.

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Credentailing, Provider Contracting

The High Costs of Provider Credentialing: What Makes it So Expensive and Time-Consuming?

If you’re a healthcare provider, you know that the process of credentialing can be both costly and time-consuming. But what makes it so expensive and cumbersome? In this blog post, we’ll take a closer look at the various factors that contribute to the high costs and long wait times associated with provider credentialing.

One of the main reasons provider credentialing is so expensive and time-consuming is the sheer number of organizations that need to approve your application. In addition to your state medical board, you’ll also need to get approval from insurance companies, hospitals, and other healthcare providers. This can take months or even years, depending on the complexity of your application.

If you are the provider, submitting the application may or may not take much of your time because it will all depend on the availability and completeness of the documents or requirements that you are to submit for credentialing. In another blog – we were able to provide you with a checklist of those needed documents to enable provider’s enrollment and credentialing. Bur credentialing as a process takes some time because of the need to complete the following tasks.

  • initiate background checks
  • collect and verify credentials, provider reputation ad case history
  • collect and review claims, privileging and board history
  • check sanctions with the Office of Inspector General (OIG)
  • begin primary source verification such as American Medical Association (AMA), medical boards and education history
  • present files to credentialing committees, executive committees and facilitate stakeholders
  • establish the delineation of privileges and provide an appointment letter

And unfortunately, this process has to be done every time a provider is credentialed and each facility will collect the same information. Each facility concerned would have its own way of doing it, creating redundancy and causing further delay in the whole process.

Why does it cost the provider so much? Slow credentialing costs providers, facilities, and the industry in general a lot of money. Lost income for the provider, less revenue for the individual facilities and an aggregate for the industry as a whole. Imagine how much better patient care could be if that wasted money was reallocated toward buying better equipment, hiring more providers, and opening more facilities. This could lower wait times, improve patient satisfaction, and ultimately lead to a quicker, more accurate diagnosis.

While there’s no easy solution to the high costs and long wait times associated with provider credentialing, there are a few steps you can take to make the process a little bit easier. First, make an effort to find a good provider credentialing company that can assist you in the whole process beginning from the application process until the renewal of your credentialing. Second, seriously work your way to complete all the required documents for submission to complete the enrollment process. And finally, be proactive and patient.

In spite of its many challenges, provider credentialing is a necessary process that helps ensure the safety and quality of healthcare. By understanding the factors that contribute to its high costs and long wait times, you can take steps to make the process a little bit easier on yourself.

We offer a variety of resources that can help you through the process. And if you have any questions, our Team of Experts is always happy to help. Reach out to us at 855-3676559. Be sure to regularly check our website for greater content.

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Credentailing, Provider Contracting

Provider Credentialing and Provider Enrollment: What’s the Difference?

If you are a healthcare provider, then you may be wondering what the difference is between credentialing and enrollment. Credentialing is the process of verifying that your qualifications meet the standards of the organization. Enrollment is the process of registering with an insurance company or health plan. In this blog post, we will discuss the differences between credentialing and enrollment in more detail, so that you can understand which process you need to go through in order to work with specific insurers or health plans.

Credentialing is the process of verifying that your qualifications meet the standards of the organization. This usually includes a review of your education, training, experience, and licensure. The credentialing process ensures that you are qualified to provide care to patients in a specific setting. For example, if you want to work as a hospitalist, you will need to go through the credentialing process in order to be approved by the hospital.

Enrollment is the process of registering with an insurance company or health plan. This process allows you to become a participating provider in their network. In order to enroll, you will need to submit your credentials for review. Once your credentials have been approved, you will be able to start providing services to patients who have that insurance plan.

The credentialing process is usually more rigorous than the enrollment process. Credentialing is important because it helps to ensure that only qualified providers are delivering care to patients. Enrollment is important because it allows healthcare providers to bill insurers for their services.

It is important to note that you cannot bill an insurer for your services unless you are enrolled in their network. This is why it is often said that credentialing is required for enrollment. However, enrollment is not always required for credentialing. For example, if you want to work as a hospitalist, you will need to go through the credentialing process in order to be approved by the hospital. However, you will only need to enroll in an insurer’s network if you want to start billing them for your services.

In conclusion, credentialing is the process of verifying that your qualifications meet the standards of the organization. Enrollment is the process of registering with an insurance company or health plan. Credentialing is usually more rigorous than the enrollment process. Credentialing is important because it helps to ensure that only qualified providers are delivering care to patients. Enrollment is important because it allows healthcare providers to bill insurers for their services.

If you have any questions about credentialing or the enrollment process, reach out to us. We are happy to help you navigate the process and get started with providing care to patients.

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Credentailing, Provider Contracting

Why You Should Outsource Provider Enrollment?

If you are a physician, then you know how vital provider enrollment is. This process can be time-consuming and frustrating, which is why many professionals choose to outsource it. Outsourcing provider enrollment can save you time and hassle, and it can also help ensure that the process is done correctly. This blog post will discuss the benefits of outsourcing provider enrollment and provide tips for choosing a credentialing company.

When it comes to provider enrollment, time is of the essence. The process can be complicated and time-consuming, so it is important to choose a credentialing company that will help you meet your deadlines. Working with an experienced and reliable company can save you time and stress, and it can also ensure that your provider enrollment process goes smoothly. Here are the benefits for you to ponder:

  • We are active in 35 states;
  • Credentialing/Re-credentialing is a necessary process in the professional life of a physician that for us, must be perfectly done from start to finish by our Team of Experts;
  • What we offer is a cost-saving option since providers can focus on the more important things – the patients and their concerns;
  • Our efficiency provides you the opportunity to save time in doing the paper works and allows you to keep up with industry updates faster;
  • Ensure faster payments from insurance and prevents the healthcare facility from losing revenues;
  • Keep up with current provider trends;
  • Improve provider’s reputation and help build strong ties with different payers.

If you are looking for a reliable and experienced provider enrollment company, consider Contracting Providers, LLC. We have solid years of experience helping professionals like you with provider enrollment and other credentialing needs. Contact us today to learn more about our services and how we can help you meet your deadlines. We are here for you.

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Credentailing, Provider Contracting

The Top 4 Tips to Make Provider Enrollment for Physicians Easier

If you are a physician looking for ways to make provider enrollment easier, you’re in luck. In this blog post, we will discuss the top four tips to make the process smoother and less time-consuming. Provider enrollment can be a daunting task, but with the right tools and information, it doesn’t have to be! Let’s get started.

Tip # One: Utilizing an experienced workforce whether internally or externally can be a huge help when it comes to the credentialing process. By working with an experienced and qualified provider enrollment company, you can take some of the burdens off your shoulders. They will handle all of the paperwork and submissions for you, making the process much simpler. If you choose to outsource, ensure the company you’re working with offers to work with your applications until they are fully accepted by the payer.

Contracting Providers, LLC has been credentialing physicians and other medical professionals since 2008. We have the experience and knowledge to get your application processed quickly and efficiently.

Tip # Two: Make sure you have all of your ducks in a row before submitting your application. This means gathering all of the required documents upfront and having a complete and accurate application. If you submit an incomplete application, it will likely be rejected and you’ll have to start the process all over again.

To save yourself time and hassle, be sure to collect all required documents before beginning the provider enrollment process. These may include:

-A completed W-905 Provider Enrollment form

-A copy of your medical license

-A copy of your DEA certificate

-Proof of malpractice insurance

Tip # Three: Have patience. Provider enrollment can often take time, especially if your application is being processed by a third-party payer. It is important to be patient and allow the process to run its course. Payer timelines vary, so it is important to be aware of their specific requirements.

If you are having difficulty obtaining a response from a payer, reach out to your Provider Enrollment representative for assistance. They will be happy to help you navigate the process and get in touch with the payer on your behalf.

Tip # Four: Stay organized. This may seem like common sense, but it is important to keep all of your enrollment paperwork in one place. This will make it easier for you to track the progress of your application and ensure that all required documents are submitted.

It can also be helpful to create a timeline or checklist outlining the steps involved in the Provider Enrollment process. This will help you stay on track and avoid any missed deadlines.

Provider Enrollment can be a challenging process, but with the right tools and information, it doesn’t have to be daunting. Follow these tips and you’ll be on your way to a smoother provider enrollment process. Make it simple! Want to know more? Reach out to us… 855-3676559

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Credentailing, Provider Contracting

Good Things To Know About Credentialing

There’s a lot of information to know about credentialing, and sometimes it can be confusing. You can always expect changes in the process or variations among payers or insurance companies. These changes would many times cause interruptions in a practice’s reimbursements and the whole revenue cycle. And because of that, it is quite important to be familiar with the changes that are happening around your profession.

  • Required documents. Knowing what documents are needed in your submission is among the very first things that you should know as a provider. Submitting incomplete or wrong documents can cause problems that will eventually lead to loss of income for the provider and the practice.
  • Banking information. The provider must have a bank account opened in the practice’s name. Enrollment can not be processed without a voided check or bank letter signed by an authorized bank official.
  • Malpractice insurance. It is impossible to have an active practice without it. Copy is required by many insurance companies and it is a must for CAQH.
  • Form of submission. In recent times, insurances companies opted for digital submission of claims to adapt to current times, situations and to ensure security and efficiency of claims processing.
  • CAQH. Many insurance companies are now turning to CAQH for credential verification. One of the largest carriers is Blue Cross Blue Shield of Michigan. Blue Cross previously requested verification through PrimeHUB; an authorized individual would attest to the information on file for a given provider, or any number of providers. Now, Blue Cross sends requests for a provider’s CAQH profile to be updated and attested for. The attestation is crucial to provider enrollment – CAQH profiles must be attested for no earlier than 14 days before submitting enrollment applications. Blue Cross has advised us that they pull information from CAQH profiles every Monday.
  • PHOs or Provider Health Organizations. Providers can join one of the many organizations that can help with credentialing. PHOs have a list of health insurance carriers that will be helpful to any provider by way of enrollment & credentialing or simply availing of information. Joining a PHO will give one an advantage over providers who are not members of a specific PHO. When a provider chooses not to join a PHO, they risk being unable to get in a network with an insurance carrier who has contracts with PHOs.

We at Contracting Providers make it our commitment to be updated in current trends and hot topics of provider enrollment and credentialing.  We make it our business to keep things easy and most convenient for you as a provider.

Want to know more? Reach out to us…855-367-6559

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Credentailing, Provider Contracting, Uncategorized

Provider Enrollment Specialist: What They Do, Responsibilities and Skills

A provider enrollment specialist is responsible for the enrollment of providers in the healthcare system. They work with both providers and insurance companies to ensure that all paperwork is completed correctly and that providers are able to be seen by patients. In doing so, the specialist is also responsible for ensuring adherence to HIPAA guidelines (and other relevant laws and regulations) and the security of private information.

The duties for this role revolve around gathering client information, reviewing applications, verifying relevant documents, processing applications, and working with clients about their concerns. Moreover, this job also includes tasks like updating databases, educating clients about policies and regulations, and assisting eligible recipients of medical insurance coverage.

If you are interested in becoming a provider enrollment specialist, then there are a few things that you can do to get started. First, you should consider completing some postsecondary coursework in business administration or health care management. This will help you to better understand the duties and responsibilities of this position. In addition, you should also consider gaining some experience working in the health care industry. This can be done by volunteering at a local hospital or health care facility, or by working as an intern or assistant in a medical office. By gaining some experience, you will be better prepared to take on the challenges of this exciting and rewarding career.

Skills that a provider enrollment specialist should have to include excellent communication, strong attention to detail, organizational skills, and the ability to work well under pressure. These, coupled with specific knowledge of data entry, Medicare, Medicaid, CAQH, CMS, HIPAA, CMS, management of provider information & effective dates, enrollment information and working with insurance companies.

There are many different types of provider enrollment specialists, each with their own set of responsibilities. For example, some provider enrollment specialists work with insurance companies to get providers enrolled in the healthcare system. Other provider enrollment specialists work with hospitals and other health care facilities to get providers credentialed and approved to start seeing patients. Still others may work for government agencies or private companies that contract with health care facilities to provide provider enrollment services. No matter what type of provider enrollment specialist you become, you will need to have strong communication and organizational skills. In addition, you will need to be able to work well under pressure and meet deadlines.

If you possess the necessary skills and qualifications, then a career as a provider enrollment specialist can be very rewarding. With the aging population and the ever-changing landscape of the health care industry, there is a growing demand for qualified providers. As a provider enrollment specialist, you can play a vital role in ensuring that patients have access to quality care. In addition, with the right experience and credentials, you may also be able to advance into management positions within the health care industry. So if you are looking for a challenging and rewarding career, then consider becoming a provider enrollment specialist.

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Credentailing, Provider Contracting, Uncategorized

Credentialing and Payer Enrollment Services

Provider enrollment and credentialing were overlooked as an important component of healthcare management practices for years. While they seemed to be tedious processes to go through, they’re quite necessary for a provider to receive in-network reimbursement from payers. Their impact on compliance issues and financial aspects of a specific practice has guaranteed that these are now the top components of any thriving practice.

The ability to accept patient insurance plans is essential for the success of any practice. Procrastination and haphazard credentialing application processing can result in significant cash-flow challenges for the providers. Fortunately, there are ways to minimize issues with enrollment and credentialing. Wanna know more about it? Keep reading.

Contracting Providers is here to ensure that your office obtains its credentials accurately and on time so that you can begin receiving reimbursement as soon as possible. We are experienced and knowledgeable in getting you through the process with the least amount of worry. You only to provide us with the required information and documents – and we will work on them for you!

How can we help you?

Our team analyzes to understand the demographics around your practice location and shortlists the most beneficial payers for you, according to subscriber density, enabling you to make an informed decision about what works best for your practice; We monitor all applications submitted and maintain accurate records for you; We communicate with you regularly to update on the progress until the process is completed; We conduct regular follow-ups to ensure that the payer timelines are met; We highly value security, confidentiality, and accuracy of your data; and with all being said, common credentialing mistakes can be avoid preventing denials and underpayments. Thus guaranteeing a healthy revenue cycle for the practice.

If you are looking for a company to help you with credentialing and payer enrollment services, we are here to guide you during the whole process. We understand the importance of getting these services in place, and we are dedicated to providing our clients with the best possible service. Contact us today to learn more about our services!

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