PROVIDER ENROLLMENT 

Credentialing Services

The first step towards payment from health insurance payers is for the provider to be setup as a vendor (or payee) for services provided to the health insurance members.  This may also include the choice to participate in the payer's provider network.  We will work the health care provider through the process:

  • Application completion with current data.

  • Follow up with the payer for status of the application.

  • Negotiation of contract.

  • Electronic payment set-up (direct deposit into provider's account).

  • EDI set-up for electronic claims transition, Electronic Remittance Advice, and electronic claim status.

Many practices utilize mid-level providers such as Nurse Practitioners, Physician Assistants, or Physical Therapy Assistants as an extension of the provider.  Some states may require mid-level providers to be credentialed or be on the roster as a group member.  This may mean the mid-level provider may have to apply and maintain their credentials with payers for payment to the practice.

We set the provider up with a HIPAA compliant secure share file to transmit sensitive data for privacy protection.  We use the data to complete any paper application and/or secure online applications such as:

  • CAQH (Council for Affordable Quality Healthcare)

  • PECOS (Provider Enrollment, Chain, and Ownership System)

  • Provider website enrollment.

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