Provider Credentialing and Enrollment Services
Trusted Provider Credentialing and Enrollment Services
Provider credentialing refers to the process by which the credentials and qualifications of a healthcare provider are verified. All doctors, nurses, and healthcare providers must attest and enroll themselves with a payer's network (insurance provider). Only then will they be authorized to provide services to patients who are members of the payer's plan. Credentialing healthcare providers ascertains that they are qualified and possess the certifications necessary to provide care to patients. Personally, it is a great way to earn patients' trust. Providers who have medical credentialing will attract more patients to their thresholds.
Credentialing is also necessary to receive reimbursement from payers. Without it, an insurance carrier can deny payment, resulting in healthcare organizations losing crucial revenue. Provider credentialing and enrollment services ensure that healthcare providers meet all the necessary qualifications and maintain their credentials over time. This not only builds trust with patients but also safeguards the financial health of medical practices. As healthcare regulations evolve, staying compliant through proper provider enrollment status becomes increasingly critical for uninterrupted service delivery and reimbursement.
DENmaar offers end-to-end provider credentialing services to make the process considerably simple and straightforward. We take the specific requirements of your medical practice into consideration and offer customized provider enrollment and credentialing services that help physicians join new organizations and practices, switch from one physician practice group to another, enroll with new payers, and maintain their credentials. Our expert provider enrollment specialists ensure that all documentation is accurate and submitted on time, reducing the risk of denied claims and helping practitioners focus on patient care.
We take the specific requirements of your medical practice into consideration and offer customized provider credentialing services that help:
➤ Physicians join new organizations and practice
➤ Switch from one physician practice group to another
➤ Practitioners enroll with new payers
➤ Practitioners maintain their credentials
Credentialing is also necessary to receive reimbursement from payers. Without it, an insurance carrier can deny payment, resulting in healthcare organizations losing crucial revenue. Provider credentialing and enrollment services ensure that healthcare providers meet all the necessary qualifications and maintain their credentials over time. This not only builds trust with patients but also safeguards the financial health of medical practices. As healthcare regulations evolve, staying compliant through proper provider enrollment status becomes increasingly critical for uninterrupted service delivery and reimbursement.
DENmaar offers end-to-end provider credentialing services to make the process considerably simple and straightforward. We take the specific requirements of your medical practice into consideration and offer customized provider enrollment and credentialing services that help physicians join new organizations and practices, switch from one physician practice group to another, enroll with new payers, and maintain their credentials. Our expert provider enrollment specialists ensure that all documentation is accurate and submitted on time, reducing the risk of denied claims and helping practitioners focus on patient care.
We take the specific requirements of your medical practice into consideration and offer customized provider credentialing services that help:
➤ Physicians join new organizations and practice
➤ Switch from one physician practice group to another
➤ Practitioners enroll with new payers
➤ Practitioners maintain their credentials
Provider Credentialing:
Speeding up the enrollment process with the payors allows you to get paid for services sooner. Whether you are starting a new practice, adding a new provider, changing practice locations, or breaking away from a group to become an individual practitioner, all require new provider enrollment applications and credentialing services. Our medical billing credentialing services ensure that your practice meets all necessary requirements quickly and efficiently, reducing the time it takes for you to begin receiving payments for your services.
Credentials Management:
Our staff ensures that they keep you credentialed and up to date with hospitals and insurers to maintain your revenue stream. All expirable credentials are proactively notified in advance to ensure all revalidations and re-attestations are completed in a timely manner. Using credentialing platforms such as CAQH and PECOS, we constantly update any changes in provider information. This meticulous approach to provider credentialing application management helps avoid any disruptions in your service and payment cycles.
Provider Enrollment:
As much as Vitality helps in getting your practice credentialed with the payors, we also ensure that all ERA’s (Electronic Remittance Advices) and EFT’s (Electronic Funds Transfers) are promptly set up to ensure a hassle-free transition to the billing departments. This comprehensive provider enrollment process is crucial for a seamless and efficient billing operation, enabling your practice to function smoothly without administrative delays.
Our enrollment services are designed to support your practice at every stage, from initial credentialing to ongoing enrollment management. Whether you need provider enrollment Blue Cross Blue Shield or any other insurer, our team has the expertise to manage the entire provider credentialing process steps effectively.
Provider Credentialing Process Flow We Adhere To
We offer a comprehensive provider credentialing service that covers the following steps:
➤ Gather all crucial data and documents from physicians that are mandatory for credentialing. This includes licenses, certifications, and professional history, which are essential for provider enrollment for Medicare, provider enrollment for Medicaid, and other insurance carriers.
➤ Store all data gathered in a secure database. We prioritize data security and confidentiality, ensuring that all information related to provider enrollment for Medicaid Florida and other regions is safely stored and easily accessible when needed.
➤ Understand the insurance carriers to which the practice sends claims and get in touch with them. This involves communicating with carriers such as Cigna for provider enrollment for Cigna, ensuring that all requirements are met for successful enrollment.
➤ Apply payer-specific formats after the due audit. Each payer has unique requirements, and our team ensures that all applications, whether for provider enrollment in Medicaid or other insurance providers, are in the correct format and meet all standards.
➤ Track application status with the payer. Our dedicated provider enrollment specialist tracks the status of each application, keeping you informed of any updates and ensuring timely completion.
➤ Obtain the enrollment number from the payer and communicate the status to the practitioner. Once the application is approved, we secure the enrollment number and update the provider enrollment status to keep practitioners informed.
➤ Update the document library consistently in compliance with the credentialing process. Our team ensures that all documents are kept current and in line with ongoing provider credentialing service requirements, maintaining compliance and readiness for any audits.
By adhering to this meticulous process, DENmaar ensures that healthcare providers can focus on delivering quality care while we handle the complexities of credentialing and provider enrollment and credentialing services.➤ Store all data gathered in a secure database. We prioritize data security and confidentiality, ensuring that all information related to provider enrollment for Medicaid Florida and other regions is safely stored and easily accessible when needed.
➤ Understand the insurance carriers to which the practice sends claims and get in touch with them. This involves communicating with carriers such as Cigna for provider enrollment for Cigna, ensuring that all requirements are met for successful enrollment.
➤ Apply payer-specific formats after the due audit. Each payer has unique requirements, and our team ensures that all applications, whether for provider enrollment in Medicaid or other insurance providers, are in the correct format and meet all standards.
➤ Track application status with the payer. Our dedicated provider enrollment specialist tracks the status of each application, keeping you informed of any updates and ensuring timely completion.
➤ Obtain the enrollment number from the payer and communicate the status to the practitioner. Once the application is approved, we secure the enrollment number and update the provider enrollment status to keep practitioners informed.
➤ Update the document library consistently in compliance with the credentialing process. Our team ensures that all documents are kept current and in line with ongoing provider credentialing service requirements, maintaining compliance and readiness for any audits.
Steps in Provider Credentialing & Enrollment
1
Documentation
Collect, validate, and securely store all imperative physician data.
2
Payer Submission
Identify relevant payers and file for credentialing while adhering to the payer-specific format
3
Ensure Enrollment
Follow up and obtain the enrollment number
4
Periodic Updates
Update document library consistently in compliance with the credentialing process.
DENmaar's Provider Credentialing Services Includes:
Our credentialing service includes the following:
➤ New Registration and renewals for individual providers. Whether you are new to the network or need to renew your credentials, our medical billing credentialing services cover all aspects of the provider enrollment application.
➤ CAQH Application Filing and Attestations. We manage the provider credentialing application process, ensuring all necessary attestations and filings are completed accurately and promptly.
➤ Maintaining provider data. Our team consistently updates and manages provider data, which is crucial for the provider enrollment process and maintaining compliance.
➤ Tracking application status and expiration dates. We keep track of your application's status and any upcoming expiration dates, providing timely reminders and updates to avoid any lapses.
➤ Creation and Maintenance of Contracts. We handle the creation and ongoing maintenance of contracts, ensuring that all agreements are up-to-date and compliant with regulatory standards.
➤ CAQH Application Filing and Attestations. We manage the provider credentialing application process, ensuring all necessary attestations and filings are completed accurately and promptly.
➤ Maintaining provider data. Our team consistently updates and manages provider data, which is crucial for the provider enrollment process and maintaining compliance.
➤ Tracking application status and expiration dates. We keep track of your application's status and any upcoming expiration dates, providing timely reminders and updates to avoid any lapses.
➤ Creation and Maintenance of Contracts. We handle the creation and ongoing maintenance of contracts, ensuring that all agreements are up-to-date and compliant with regulatory standards.
Benefits of utilizing DENmaar's Credentialing and Enrollment Services
You enjoy the following benefits with our credentialing services
➤ Speedy credentialing with all payers. Our efficient processes ensure quick credentialing, including provider enrollment in Blue Cross Blue Shield and other major insurers.
➤ Drastically reduced claims denial rates. By adhering to the precise provider credentialing process steps, we minimize the chances of claims being denied, ensuring smoother operations and better cash flow.
➤ Increased patient referrals from the network. Being part of a network increases your visibility and patient referrals, contributing to the growth of your practice.
➤ Reduced paperwork. Our services significantly cut down on the administrative burden, allowing you to focus on patient care instead of dealing with complex paperwork.
➤ File cumbersome application forms without a hassle. We handle the entire provider enrollment process, including filing complex application forms efficiently.
➤ Track the status of your application. Stay informed about your application's progress with our reliable tracking system.
➤ Reduced cost of credentialing. Our streamlined approach and expertise reduce the overall cost and time associated with the credentialing process.
DENmaar's enrollment planning service ensures that all aspects of your credentialing and enrollment are managed with the highest level of professionalism and efficiency, allowing you to concentrate on what you do best – providing excellent patient care.
➤ Drastically reduced claims denial rates. By adhering to the precise provider credentialing process steps, we minimize the chances of claims being denied, ensuring smoother operations and better cash flow.
➤ Increased patient referrals from the network. Being part of a network increases your visibility and patient referrals, contributing to the growth of your practice.
➤ Reduced paperwork. Our services significantly cut down on the administrative burden, allowing you to focus on patient care instead of dealing with complex paperwork.
➤ File cumbersome application forms without a hassle. We handle the entire provider enrollment process, including filing complex application forms efficiently.
➤ Track the status of your application. Stay informed about your application's progress with our reliable tracking system.
➤ Reduced cost of credentialing. Our streamlined approach and expertise reduce the overall cost and time associated with the credentialing process.
DENmaar's enrollment planning service ensures that all aspects of your credentialing and enrollment are managed with the highest level of professionalism and efficiency, allowing you to concentrate on what you do best – providing excellent patient care.
Why Outsource Medical Credentialing to DENmaar?
At DENmaar, our physician credentialing services ensure that your practice runs effectively, allowing you to become a participating provider and strengthen your revenue cycle management. Our goal is to facilitate uninterrupted workflow for better financial outcomes by handling all your credentialing needs with precision and efficiency.
We understand the critical importance of credentialing documents in healthcare procedures. Our team emphasizes growing your practice in compliance with all contractual payers through facilitated credentialing practices. By partnering with us, you can be assured that all credentialing requirements are met seamlessly, helping you maintain compliance and avoid disruptions in your service delivery.
To prevent revenue loss, our team verifies enrollment status before commencing submissions. We also validate EDI (Electronic Data Interchange) and EFT (Electronic Funds Transfer) agreements to streamline the process. This thorough approach ensures that your claims are processed smoothly, reducing the risk of denials and improving cash flow.
Our commitment to service satisfaction sets us apart in the market. The dedication and expertise of our team are reasons why medical practices continue to trust and work with DENmaar for their credentialing needs.
We understand the critical importance of credentialing documents in healthcare procedures. Our team emphasizes growing your practice in compliance with all contractual payers through facilitated credentialing practices. By partnering with us, you can be assured that all credentialing requirements are met seamlessly, helping you maintain compliance and avoid disruptions in your service delivery.
To prevent revenue loss, our team verifies enrollment status before commencing submissions. We also validate EDI (Electronic Data Interchange) and EFT (Electronic Funds Transfer) agreements to streamline the process. This thorough approach ensures that your claims are processed smoothly, reducing the risk of denials and improving cash flow.
Our commitment to service satisfaction sets us apart in the market. The dedication and expertise of our team are reasons why medical practices continue to trust and work with DENmaar for their credentialing needs.
Frequently Asked Questions
What is provider credentialing?
Provider credentialing refers to the process that helps providers get affiliated with insurance carriers. The process helps patients use their health insurance to pay for the healthcare service while aiding healthcare providers to get reimbursed for their services.
What is essential information required to credential a provider?
Important information about a provider’s education qualifications, practice license, affiliations, malpractice history, training, experience, certifications, etc., are needed to credential a provider.
What sets DENmaar's credentialing services apart?
DENmaar’s credentialing services stand out due to our comprehensive approach that ensures compliance with all contractual payers, proactive management of expirable credentials, and seamless integration with billing departments. Our expert team handles the entire process, from data gathering to maintaining up-to-date credentials, ensuring that your practice experiences minimal disruption and maximizes revenue.
How does DENmaar expedite provider enrollment?
DENmaar expedites provider enrollment by utilizing a streamlined process that includes the accurate collection and secure storage of necessary documentation, direct communication with insurance carriers, and the application of payer-specific formats. Our dedicated team tracks application statuses diligently, ensuring quick turnaround times and prompt updates to keep you informed every step of the way.
How long does the provider enrollment process take?
The provider enrollment process typically takes between 60 to 90 days, depending on the specific payer and the completeness of the submitted documentation. DENmaar works diligently to reduce this timeline by ensuring all applications are accurate and complete before submission, thus minimizing delays caused by errors or missing information.
How does DENmaar handle the management of expirable credentials?
DENmaar proactively manages expirable credentials by tracking expiration dates and notifying providers well in advance. We ensure that all revalidations and re-attestations are completed on time, keeping your credentials current and compliant with hospital and insurer requirements, thereby maintaining your revenue stream without interruption.
TESTIMONIALS
What Our Clients Say?
“Using DENmaar Psychiatric Billing to do your credentialing is the one most important piece of advice I gave to a colleague starting her own behavioral health practice.”
Brighid Gannon
“Boy, I remember my reports from my former billing person…….I can only blame myself for not finding you sooner.”
Sheridan Jackson
“It is such a relief for me to have someone like you to rely on to make sure my income has a steady flow. Sooo different than my previous biller!”
Stacy Kim Johnston
