Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.  Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in your practice - failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request. Trust Access Healthcare to get you credentialed fasters as we understand the forms required by each payer, and their policies and procedures.

Provider Credentialing

The process involves the following steps:

• Application Evaluation. Completing required documentation and identifying exceptions.

• Primary Source Documentation. Verify practitioner/ facility information from physicians.

• Outbound Call Center. Obtain missing documents and updating the payer's database.

• Follow-up with payers. Follow-up on submitted credentialing requests.

• Data Entry. Capture data, label, and link images to specific providers/ facilities in the payer's database.

• Maintenance of Provider Data. Update provider information as per policies and procedures, and CAHQ profile.

Provider enrollment

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:

• Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims

• Updating practice’s Pay-to address. Validate and update the provider's pay-to address or the billing address

• Enrolling for electronic transactions. Our team can enroll providers for four types of electronic transactions:

  • Electronic Data Interchange (EDI)

  • Electronic Remittance Advice (ERA)

  • Electronic Fund Transfer (EFT) and

  • CSI

• Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

Provider Credentialing and Enrollment Services Allow you to:

• Keep your data up-to-date with payers

• Process faster payments from insurance and get more patient referrals

• Mitigate revenue leakage

• Avoid piles of paperwork and filling out application forms

• Reduce denials and identify provider trends

• Build relationships with different payers.

• Receive real-time status of credentialing and enrollment transactions.

Contact us to learn more about Access Healthcare's Provider Credentialing and Enrollment Services.

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