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Medical Credentialing Services

Medical Credentialing Services

Credentialing, re-credentialing, provider updates, and data changes are incredibly important, yet burdensome responsibilities for medical offices. Time wasted on hold, trying to understand each insurance company’s processes is costly and time-consuming.

At Billing Advantage, our specialists take the stress and guesswork out of completing the credentialing process. By outsourcing to us, you’re guaranteed to have quality, up-to-date verification with just a few simple steps. Whether you’re a medical practice, a hospital, a surgery center, or a solo practitioner, we customize our credentialing and provider enrollment services to your specific needs.

The Credentialing Process in Medical Billing

medical treatment billing statement with stethoscope in background for medical credentialing

Provider credentialing involves checking a healthcare professional’s medical qualifications to prove their eligibility in administering patient care. It’s best to initiate when a new hire is onboarded. Many healthcare providers, including Medicare and Medicaid, will request credential verification to become an in-network provider. We can help you determine which insurance, HMOs, and PPOs are the most widely used plans in your area.

At Billing Advantage, our credentialing a la carte services cover the following:

  • Determining if you are qualified to apply for in-network status with numerous health insurance companies, HMOs and PPOs.
  • Access the paperwork needed to apply.
  • Fill-out online applications, such as CAQH, and apply to obtain an NPI.
  • Follow-up and track your application status while supplying missing information as needed.
  • Complete any re-credentialing paperwork as requested by insurance plans.
  • Research your geographic area to determine the most common payers to apply to.
  • Applications to insurance payers for individual providers or groups
  • CAQH maintenance and updating
  • Payspan, EFT, and Optumpay setup
  • Changes and updates to address, phone numbers, and rosters
  • Medicare re-validations
  • Hospital Admitting Privileges
  • DEA License
  • State License
  • NPI Creation
  • and more

Insurance Credentialing Services

Insurance credentialing, otherwise known as provider insurance credentialing, is essential for every practice in today’s day and age. Without it, your practice would be unable to apply for provider panel inclusions with insurance companies. This process allows you to bill insurance companies as in-network providers. Once you meet specific criteria and are accepted, you’re then able to bill payers for your services.

Provider Re-Credentialing

Re-credentialing involves periodically reviewing and verifying that your staff’s medical credentials are up-to-date. This process certifies education and training and also alerts healthcare organizations of fraud. In most states, re-credentialing is required for medical providers every two years. Neglecting so may result in penalties, takebacks, and sanctions.

Medical Credentialing Solutions You Can Trust

Medical credentialing and re-credentialing are unarguably the most effective ways to ensure your provider information is accurate and up-to-date. Plus, they guarantee your affiliation with insurance plans, which in turn provides you with third-party reimbursement for your patient care.

To get started, all we need from you is to compile and fill out some paperwork. Then, you can leave the time-consuming tasks to us. It’s important to note that medical credentialing is a lengthy process. Depending on the insurance carrier, the enrollment process can take up to six months to fully complete.

Once you’ve collected your documents and are ready to move forward, connect with our specialists today. For more detailed information, contact us at 866-331-3345.

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