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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CAQH, Maintenance

CAQH: Definition, Explanation, Importance

Council For Affordable Quality Healthcare Defined And Explained

CAQH: The Council Defined

CAQH, or the Council for Affordable Quality Healthcare, is a non-profit organization of national healthcare networks and plan providers whose objective is to improve the quality of healthcare and its accessibility. It’s primarily designed for providers and their staff in order to eliminate confusion, reduce paperwork, and streamline information gathering and dissemination.

Many healthcare providers or physicians must have a contract with multiple organizations in order to provide adequate healthcare to their patients. This is time-consuming and expensive. The Council aims to eliminate the need for multiple contracts through the consolidation of services. Healthcare providers and organizations will contract with the Council and complete a single application with a single source, which is the Council. Information can be updated with one source rather than multiple organizations, which saves time and money for the provider.

The Council Explained
The council is a service provided to healthcare organizations such as hospitals, insurance companies, and doctors’ offices to simplify provider access. Members don’t have to contract with multiple organizations in order to meet their patient obligations; rather they obtain it from the Council. The Council is the repository for the information collected from the providers so that when members need contract work, it’s easily obtained.

Removing the necessity of multiple contracts enables healthcare providers to spend more of their time on providing healthcare to their patients rather than tending to administrative duties. It also ensures that contract companies will be of high quality and fully vetted before interfacing with patients or conducting transactions within the medical or dental setting.

Security Of Information
Each provider submits a single application to the Council and it’s stored in a confidential database that’s routed through multiple firewalls in order to ensure privacy and eliminate hacking. Security is further ensured by 128-bit Secure Socket Layer encryption and only users with password and PIN authentication can access the data.

Only healthcare organizations who are authorized by the patient can access the patient’s records, and providers have access to their records but not those of other organizations. The Council is moving toward full automation of the authorization process so that pre-approvals will be more accurate and more consistent without human interface, but the fully automated objective is still in process.

Who Should Use The CAQH System?
Medical doctors, osteopathic doctors, podiatrists, nurse practitioners, dentists, licensed psychologists, some physical therapists, some oral surgeons, and others can use the Council. For more information, check web-DENIS or visit the Council’s website at Members have found that using the Council eliminates considerable paperwork in their offices, and it decreases the likelihood of user error since the data is entered once when it’s input into the provider enrollment database. Although previously used primarily by those in the medical field, dentists are finding it to be very advantageous, and it’s expected to be the leading source in the industry for data on dentists’ credentialing.

Another attractive feature of this system is their webinars. Members, including participating organizations, can easily train their employees in the use of the system through scheduled webinars on their website. A variety of dates and times are available so that members can train their employees at their convenience.

Locating participating healthcare providers is as close as the internet using the List of Participating Organizations on the website. Health plans, PPO networks, dental organizations, hospitals, and many more are located on this page and can be an invaluable resource, providing accurate information in an instant.

Use Of Information
Information on those who enroll in the program will be entered by the organization responsible for updating corporate provider information, which is the Provider Enrollment and Data Management organization. No one else will have access to an entity’s information except those that are specifically authorized by the entity. Information that is available to the Provider Enrollment and Data Management organization includes the physical, billing, and payment addresses, the specialty, and the tax identification number. These items are essential elements of providing contracts, so they must be kept current.

Updated Information
In order to maintain the most accurate database possible, the Council recommends that members update their information at least quarterly or every four months at most. Members are sent electronic reminders to verify the accuracy of their data, but changes should be reported immediately, either online or with a phone call. CAQH has a new system. Artificial intelligence, or AI, has been developed that will improve the accuracy of their data without the need for provider interface. This revolutionary, patent-pending process will ensure that their database is as current as possible and eliminate the need for human updates that cost time and money.

Cost Of The Program
Healthcare organizations and plan providers pay a fee to access the information in the provider enrollment database but users aren’t assessed a fee for obtaining information. Medical and dental providers have found that using the Council can save millions of dollars annually because they don’t need to duplicate the efforts that the Council has made; accurate information is already in the provider enrollment database.

Quality Control
The Council’s database also maintains credentialing solutions that enable others to verify the status of a provider. Any sanctions or infractions against a provider will be included, so members can provide their patients with the best care possible.

Advantages Of Using CAQH
Consolidation of information can save millions of dollars each year while maintaining the most current and accurate information available on its members. The Council provides the most reliable list of benefits for individuals and its credentialing process ensures that patients receive care from competent providers. Especially for new medical or dental practices, the Council can make a significant difference in their bottom line.

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Credentailing, Maintenance

Maintaining Credentials

The Importance of Maintaining CredentialsHow Do Doctors Obtain Insurance Credentials?

In order for doctors to obtain credentials from an insurance provider, they have to pass a screening process to obtain what is termed “Medical Credentialing.” At, we help reduce your application rejection rates and negotiate the maximum premiums. We also manage all the documentation and submit the applications for you. All we need are key documents that each insurer may require to screen your practice for admissibility, such as W-9 forms, DEA numbers, proof of insurance, and licenses.

Many health insurance providers are pretending that they are closed to applicants as a polite alternative to flat-out rejection letters. However, the majority have simply become hypercritical of which doctors they will affiliate with to ensure the best value for their patients. Obtaining approval with multiple insurance companies to accept a broad spectrum of patients requires special skills and experience. Nevertheless, is able to offer our Medical Credentialing” outsource maintenance services for less than $75 month.

We connect you with numerous insurance providers and save you the hassle of following up with them during lengthy application processes. Some processes can take 9 months or more and leave you guessing about what to do next. We file any appeals without additional charge if you are rejected for any reason. In some cases, we can identify errors regarding the decision and clear them up to win you approval.

Lack of Out-of-Network Reimbursements

Another major trend in the health insurance field is the lack of out-of-network reimbursements. Patients today are being forced to rely solely on the healthcare providers associated with their health insurance company. Doctors have to face the reality that they are being denied the bulk of business due to such exclusive contracts. The only way to reclaim that business is to obtain credentials and contracting from the healthcare providers.

This type of exclusive contracting of services is nothing new. Most stores are required to exclusively carry the merchandise of a particular distributor. If they violate the terms, then they face stiff penalties. While some distributors may leave the door open for select local goods that draw in crowds to also sell their products, few distributors are willing to negotiate beyond that. This ensures that their products do not face any competition or inferior perception issues.

The patients who choose out-of-network providers are, likewise, often penalized with additional fees if they do so. In order to benefit from this trend in the medical industry, you have to ensure that your practice is on the right side of the fence. It is impossible to buck the trends that are being mandated by law and shaped by politics.

The only way to ensure the long-term survival of your practice is to partner with as many insurers as possible. The insurers then work to ensure that your services are presented as the best alternative as opposed to other providers outside of the network. In this sense, the lack of out-of-network providers is a negative trend only if you are on the wrong side of it.

And when you hire us, we are able to provide the competitive edge that you need to pass the strict scrutiny of Medical Credentialing gatekeepers. Our services add that touch of error-free professionalism that can persuade providers and make the screening departments’ jobs easier. Outsource maintenance of your affiliate contracting to us and eliminate the worries.

Retaining Out-of-Pocket Patients

Your out-of-pocket patients will always be there if you continue to deliver the high quality of services that they require. And you can even provide them the same additional level of attention if they are paying a higher premium than negotiated insurance flat rates.

But when you are able to contract with major insurers, it is also easier for you to recommend a full range of services that patients may not otherwise be able to afford. And you never have to gouge any one customer because you will accumulate sufficient income by keeping busy and treating a higher volume of patients without frittering away endless dollars on pointless advertising.

It is pointless to spend a lot of money on advertising your services if the potential market is non-existent. We have already covered the scarcity of wealthy out-of-pocket customers. Unless you provide some exceptional service that is not covered by insurance that people absolutely need you alone to solve, the patients will always choose one of the providers in their network. It is a no-brainer!

Managed Healthcare and the Affordable Healthcare Act have completely changed the game for medical practitioners. Mandatory healthcare coverage has made cash-in-hand customers virtually extinct. Although some practitioners, such as cosmetic surgeons, like to offer financing programs for large medical bills and partner with lenders, they still try to bill anything they can under medical necessity. They accomplish this by citing any potential cancer risks or other major health concerns involved in a treatment, scar removal, surgery, etc.

Contact Us

If you want a one-stop-shop solution to obtain and maintain credentials with insurance companies, look no further than Our business model keeps our overhead down and allows our team of experts to handle all your credentialing needs for under $75 a month. If you obtain even one customer, as a result of our services, the value of customer acquisition has paid for your annual bill at least ten times over.

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