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Medical Billing and 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.

Provider Credentialing: What We Can Offer You

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. medical billing and credentialing specialist working

What is covered under healthcare credentialing?

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.

Physician 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.

Credentialing Services for Providers 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.

Doctor Credentialing

Hospital Credentialing

Mental Health Credentialing Services

Albeit time-consuming, doctor, medical, and hospital credentialing are all necessary and legal requirements that ensure your patients stay safe and are taken care of properly. If done correctly, it also protects your hospital or facility and providers by verifying that education requirements, prior work experience, licensure, medical training, insurance, and backgrounds are accurate and up-to-date.

With a 30+ year track record, we’re the best in business when it comes to medical credentialing solutions. Our up-to-date technology and knowledgeable team members can help you save you time and money. Contact us today or read our FAQs below to learn more!

Get Reimbursed by Insurance Companies

Contact us today to ensure your office is getting paid for the work that you do.

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Frequently Asked Questions

For most, the credentialing process generally takes anywhere from 2 to 6 months.

To help the process move along as quickly as possible, it’s best to respond to all requests from our team promptly and thoroughly.

It typically takes around 2 to 4 months to complete the credentialing process for a provider with Medicare.

It usually takes around 2 to 6 months to credential a provider with insurance companies.

During the credentialing process, we have you fill out and complete an information sheet that includes important information, such as name and address of provider, NPI, Tax ID, Licensing documentation, etc.

It varies by insurance; re-credentialing is often done every 2 years.

Provider credentialing is the process of applying for a provider to be “in-network” with an insurance company, meaning you are part of their panel of providers. This allows you to bill that insurance company as an in-network provider.

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