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Medical Provider Credentialing
Build your best practice
Start-Up Contracting & Credentialing
Experts Are At Your Fingertips
Accept insurance easily, simplify claims, and streamline your practice —We help you collaborate with insurance networks to complete payor enrollment and credentialing for your organization’s healthcare providers. We specialize in provider and facility credentialing and re-credentialing for all specialties, including FQHCs.
Since this can be a long, tedious process, our team of credentialing experts follows up with payors until you become fully enrolled.
Experts Are At Your Fingertips
Start-Up Contracting & Credentialing
Experts Are At Your Fingertips
Credentialing isn’t brain surgery, but it is an arduous process for even the seasoned expert. We guide you efficiently through the enrollment and contracting process using years of experience, understanding, and strategic relationships with insurance payers. Our package allows you to open sooner and quickly collect a return on your investment. A delay in the enrollment and contracting process directly affects a practice’s profitability. As a result, we do our part to limit our client’s risk of payer (and revenue) delays.
Start-Up Contracting & Credentialing
Start-Up Contracting & Credentialing
Start-Up Contracting & Credentialing
- Identification of the top payers in your area based on your location
- Provision of an account manager to assist you in starting your new therapy business.
- Management of all credentialing and contracting with commercial payers
- Enrollment services for government payers like Medicare, Medicaid, & Tricare
- A clearinghouse’s link with payers is EDI enrollment for government and commercial payers
- Assistance with ERA/EFT enrollment for commercial and government payers
- Timely submission of all claims made by your billing department
- Reporting on deliverables every month
Timeline
Not Just Your Average Credentialing Company
Start-Up Contracting & Credentialing
How long does it take to get your practice up and running? This depends on various challenging factors. Fortunately for you, we always love a good challenge. Our knowledge of insurance payers, including those that provide retroactive dates, ensures that we provide the most accurate timeframe.
Who We Help Get Credentialing
Not Just Your Average Credentialing Company
Not Just Your Average Credentialing Company
- Provider Enrollment & Credentialing Services
- Individual & Group Medicare Enrollment
- Medicaid Enrollment for Group & Individual
- Insurance Contract Negotiations
- Payer Fee Schedule Creation & Evaluation
- Telemedicine Credentialing
- Lab enrollment services (CLIA)
- Medical License Application Processing & Renewals
- DEA Registration & Renewals
- CAQH Registration & Enrollment
Not Just Your Average Credentialing Company
Not Just Your Average Credentialing Company
Not Just Your Average Credentialing Company
All our team members are highly specialized and include certified coders, credentialing specialists, telemedicine experts, and former practice managers. Working with our professionals will ensure you avoid slight mistakes, saving you time and money.
Many providers rely on us for credentialing every year, and we would love to help you. We offer comprehensive credentialing services and payer enrollment technology catered to the specifics of your practice, billing consulting, telemedicine credentialing, contract negotiations, and practice start-up services. Each business is different, but customer service, integrity, and efficiency are universal.
healthcare services, medical billing, revenue cycle management, credentialing, US-based,
Credentialing
Key Components of Provider Credentialing
Key Components of Provider Credentialing
Provider credentialing is not a one-time process; rather, it is ongoing, as providers will need to be re-credentialed approximately every three years. This process is essential for the provider, the health organization, and patients to ensure they receive the most vital care. Provider credentialing involves a thorough verification of a pr
Provider credentialing is not a one-time process; rather, it is ongoing, as providers will need to be re-credentialed approximately every three years. This process is essential for the provider, the health organization, and patients to ensure they receive the most vital care. Provider credentialing involves a thorough verification of a provider’s qualifications, including their education, training, experience, and licensure. Utilizing platforms like AthenaHealth can streamline this process, while Dyer Medical Billing helps manage the healthcare revenue cycle, ensuring a seamless experience throughout the credentialing journey.
Key Components of Provider Credentialing
Key Components of Provider Credentialing
Key Components of Provider Credentialing
Credentialing is essential for maintaining high standards of care, ensuring patient safety, and meeting regulatory and legal requirements within the healthcare revenue cycle. Provider credentialing involves several critical steps, including:
Education and Training Verification: This phase ensures that the healthcare provider has the nec
Credentialing is essential for maintaining high standards of care, ensuring patient safety, and meeting regulatory and legal requirements within the healthcare revenue cycle. Provider credentialing involves several critical steps, including:
Education and Training Verification: This phase ensures that the healthcare provider has the necessary educational and training background. It includes validating records from medical school, residency, fellowships, and any additional training.
Licensure Verification: In this part, healthstate authorities verify that providers hold valid licenses to practice medicine in their respective states.
Work History and Experience: A comprehensive evaluation of the provider’s work history is conducted to confirm they have relevant experience in their field.
Background Checks: This process entails reviewing the provider’s criminal record, malpractice claims, and disciplinary actions, typically covering a background check period of 5 to 10 years or sometimes longer.
Peer References: Providers will need peer references from other healthcare professionals who can vouch for their credibility and competence.
Specialty Certification: For certain specialties, additional accreditation may be required, which is also validated throughout the credentialing process. Services like Dyer Medical Billing can assist with these steps to streamline the credentialing process, potentially integrating with systems such as AthenaHealth for enhanced efficiency.
The Credentialing Process
Key Components of Provider Credentialing
Challenges in Provider Credentialing
While every healthcare provider has a slightly different credentialing process, there are some general steps that they will follow. Each credentialing process is meticulously performed and requires time, often taking several months to complete fully. Here is the general process: Data Gathering involves the applicant compiling the necessar
While every healthcare provider has a slightly different credentialing process, there are some general steps that they will follow. Each credentialing process is meticulously performed and requires time, often taking several months to complete fully. Here is the general process: Data Gathering involves the applicant compiling the necessary materials for submission. An applicant will need to provide copies and evidence of all required documentation. Application Submission follows, where a healthcare provider submits a thorough application that includes personal information, educational background, employment history, references, and other pertinent details. The Verification of Credentials stage begins once the application is submitted. The credentialing body, which could be a hospital, insurance company, or an independent credentialing organization like AthenaHealth, starts the verification procedure by contacting institutions, licensing boards, and other relevant agencies to confirm the authenticity of the provided information. Next, a credentialing committee conducts a review of the application after all credentials have been validated. This committee typically consists of healthcare specialists and board members who assess the provider’s qualifications and abilities to deliver care. If the application is approved by the committee, the provider is officially credentialed. This approval may also involve enrollment in specific healthcare networks or insurance panels, allowing them to serve a larger patient population. Ongoing Monitoring and Re-credentialing are essential, often required every three years, ensuring that providers maintain their qualifications and adhere to evolving healthcare standards. The duration of the credentialing process can vary based on factors such as the depth of the verification process and the responsiveness of the entities involved. Delays may occur if inconsistencies arise in the provided information or if additional details are necessary, impacting the overall healthcare revenue cycle managed by organizations like Dyer Medical Billing.
Challenges in Provider Credentialing
Key Components of Provider Credentialing
Challenges in Provider Credentialing
While provider credentialing is a routine process for many healthcare professionals, it is not without its challenges. Here are some common problems that providers and specialists may encounter in the credentialing process.
**Complexity and Time-Consuming Process**
Credentialing cannot be completed in a day. The provider credentialing
While provider credentialing is a routine process for many healthcare professionals, it is not without its challenges. Here are some common problems that providers and specialists may encounter in the credentialing process.
**Complexity and Time-Consuming Process**
Credentialing cannot be completed in a day. The provider credentialing process is often multi-faceted and time-intensive, requiring the collection and verification of a wide range of documents and information. This complexity can lead to delays, which can be particularly frustrating for physicians eager to start practicing or for healthcare facilities in need of their services. Generally, this process can take around 3-4 months, impacting the overall healthcare revenue cycle.
**Varying Standards and Requirements**
The standards and regulations for credentialing can differ significantly between jurisdictions, healthcare systems, and insurance organizations, including those utilizing systems like AthenaHealth. These variations across states can result in confusion and added workload for providers who operate in different environments or across state lines.
**Data Management and Privacy Concerns**
The extensive amount of sensitive personal and professional information involved in credentialing raises significant data privacy and security concerns. Ensuring the security and integrity of this information is a critical issue that cannot be overlooked, especially for firms like Dyer Medical Billing that handle such data.
**Credentialing Errors and Inaccuracies**
Credentialing errors, whether stemming from incorrect information or miscommunication, can have serious consequences. They can lead to delays, credentialing denials, and even legal issues that impact the entire healthcare revenue cycle.
**Keeping Up with Continuous Changes**
Healthcare legislation and standards are continually evolving. Maintaining compliance with credentialing processes and staying abreast of these changes is an ongoing challenge for credentialing bodies and providers alike.