Medical Credentialing Service
Ensure quality care, protect patient safety, and increase practice revenue
Types of Credentialing
Payer Enrollment, also known as payer credentialing, is required for providers to contract to provide services to the patients insured by each insurance company. It applies to providers starting a new practice and existing practices adding a new provider or location. Our credentialing team gathers the required information to complete submit the payer applications and contacts the insurance company regularly to inquire on credentialing status. The overall credentialing process takes 90 days to six months for each payer.
Maintenance credentialing is offered after the initial credentialing process to ensure key documents and credentialing contracts don’t expire or lapse. Our credentialing team tracks important due dates, expiration dates and re-credentialing dates (five years for Medicare) and reports to the client regularly when something needs attention. We complete all re-credentialing applications and update CAQH (national credentialing database) quarterly on behalf of the provider.
Primary Source Verification
Primary source verification, also known as delegated credentialing or provider credentialing, is the process of verifying the validity of a provider’s credentials in the same way an insurance company would do for payer enrollment above. Large organizations are generally required to credential their own providers per their contracts with the payers. These organizations can outsource this service to our credentialing team.
FAQ: Getting Started with Credentialing
A: It is the process in which the provider participates with insurance companies to submit claims and receive payments.
A: Typically, this would be the office manager who completes the forms on behalf of the provider or the provider themselves. They can also utilize a hired credentialing company.
A: Providers should begin this process as soon as their Tax ID and Group NPIs are assigned. Medicare payers typically take the longest, so it should be the first payer to start.
A: Providers could be faced with claim denials for being non-participating or could be paid out of network, causing patients to have larger out of pocket expenses.
To learn more about how Harris Ambulatory Group’s solutions can help your practice, reach out to us today.