Provider credentialing and enrollment services is a process of enrollment and attestation that a physician is part of a Payer’s network and authorized to provide services to patients who are members in the Payer’s plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.
Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively.
Starting a new practice.
Switching from one physician practice group to another.
Join or become affiliated to new groups or practices.
Enroll with new payers (including DME credentialing).
Workers Compensation Credentialing.
Monitoring & Maintain the provider credentialing services.
Updating practice’s Pay-to address.
2. Enrolling for electronic transactions.
Electronic Data Interchange (EDI)
Electronic Remittance Advice (ERA)
Electronic Fund Transfer (EFT) and
CSI
CAQH application completion and attestation.
NPI Registration (Type I and type II).
Group & Individual Medicare Revalidation.
PECOS/ I&A updates.