Services  >  Credentialing

Credentialing

Physician Revenue Solutions handles payer enrollment needs and requirements, alleviating you from these time-consuming tasks.

WHAT IS CREDENTIALING?

Credentialing is the process by which hospitals, healthcare organizations, and insurance carriers obtain and evaluate the proper documentation for medical practitioners to join a network or to treat patients at a medical institution. Credentialing involves contacting various organizations, such as medical schools and licensing boards, to verify a provider’s education, training, licensure, work history, regulatory compliance record, as well as malpractice history. This ensures that there are no issues that would deem a provider as incapable of adequately treating patients.

WHY IS CREDENTIALING IMPORTANT?

Timely and complete handling of credentialing requirements is critical to the health of your revenue cycle. Delays in enrollment of a new provider or missing the re-credentialing of an existing provider can have a negative financial impact on your practice. Specifically, insurance carriers will not reimburse any medical office bills for services provided by those who have not been properly credentialed. 

At Physician Revenue Solutions, our team will handle the payer enrollment obligations for your practice. Working alongside your staff, we help obtain the necessary documents and submit them on your behalf. We track the submission process and perform follow-up checks to ensure your practice meets all credentialing and re-credentialing requirements.

THE CREDENTIALING PROCESS

Collect all the required data from the physicians for the filing of credentialing applications

Develop an appropriate credentialing strategy by selecting the top payers to which the physician’s practice sends claims

Audit the application for accuracy and completeness (then file the application)

Submit the filled-up credentialing forms to the insurance carriers either chosen by the physicians or as recommended by e-care

Follow-up with the insurance carriers on a regular basis to track the status of the applications

Obtain the enrollment number from insurance carriers and communicate to the physicians

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