Credentialing & Enrolment
Provider credentialing is the process of getting a physician or a provider associated with payers. It is a critical step in revenue cycle. It enables the provider to get reimbursed for the medical services provided to patient, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance policy in the practice Effective Credentialing Services which is the absolute necessity for good practice. Without proper enrolment, payments can be delayed or refused by the insurances, even if the physician is able to provide services that are competent and medically necessary.
Completing Application with required documentation
Verifying practitioner / facility information from physicians.
Obtain missing documents and updating the insurance carriers.
Follow-up on submitted Applications
Updating provider information as per policies and procedures, and CAHQ profile.
Updating contracts with payers
Collect Documentation And Validate Catalog And Store.
Documentation
Collect documentation and validate, catalog and store.
Payer Submission
Identify top payers and file the application in payer-specific format.
Ensure Enrollment
Timely follow-up of application and obtain the enrollment.
Updates & Credentialing
Periodic updates of the payer documents for recredentialing