Credentialing is the process of review and verification of the information of a health care provider who is interested in participating with Various Insurances in their County.

Review and verification includes: current professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance.

The process begins with requesting Credentialing Application Kits from all the commercial and government health Insurances.

After submitting the signed applications we follow-up with the payers to retrieve the Provider or Group ID # confirming that the doctor is participating with the insurance. We also give bi-weekly status updates to the provider until an effective date of enrollment is determined so the provider can begin claim submission.

New Credentialing Services:

• - Completion of Credentialing Applications with Various Health Plans & Follow-Up Until Credentialed
• - Review of Contracts
• - Assistance Obtaining CAQH ID
• - Assistance Obtaining NPI #

Credentialing Maintenance Services:

• - Completion of Re-credentialing Applications with Various Health Plans
• - Medicare Re-Validation
• - CAQH Re-Attestations
• - Expirables Management
• - Assistance with Denied Claims Due To Credentialing Issues