Best Credentialing Companies for Surgery Practices 

As a surgeon, you must deal with complicated patient care, making time for surgeries and other office duties. Adding medical credentialing to that mix can feel overwhelming. The process of credentialing can take a long time and affect providers in prioritizing quality medical care because of insurance credentialing, hospital privileging, and compliance needs. 

Professional credentialing companies specialize in navigating the complex landscape of surgeon credentialing. These services ensure your practice maintains active enrollment with insurance companies and hospital networks. Hence, the best credentialing companies for the surgeon list can help you select the right partner for your needs. 

Why Surgeon Practices Need Credentialing 

Credentialing is the basic process of making sure that doctors have verified surgery licensing, diplomas, and other qualifications. Here’s why surgical practices need credentialing: 

• Insurance Network Enrollment: Before companies like Aetna, UnitedHealthcare, and BlueCross BlueShield will pay your practice back for services to patients, they need to see proof of your doctor’s valid documentation. They verify your National Provider Identifier (NPI), medical school credentials, board certifications, DEA registration, and malpractice history. 

• Hospital Privileging: Surgeons need to be given permission to work at the hospitals where they can perform surgeries. This credentialing process makes sure you are qualified to perform specific procedures at a specific healthcare institution. 

• CAQH Enrollment: The Council for Affordable Quality Healthcare (CAQH) keeps a central record of all providers’ qualifications. This database is used by many insurance companies and healthcare systems. 

• HIPAA Compliance: According to HIPAA, your credentialing method must keep private doctors’ information safe. Professional credentialing companies know how to follow these rules and keep their processes safe. 

• Ongoing Compliance: After getting their credentials, providers need recredentialing every two to three years. State Medical Boards require updates, payers demand current information, and regulations regularly change. Without active management, credentialing lapses can cause reimbursement delays. 

Top Credentialing Companies for Surgeons 

To help you choose the best credentialing partner, the following is a list of the top credentialing companies for surgery practices. 

Credex Healthcare 

Credex Healthcare specializes in medical credentialing for healthcare providers across multiple specialties, with deep expertise in surgical practices. They understand the unique administrative challenges surgeons face, particularly regarding hospital privileging and insurance network enrollment. 

Services Offered 

Credex Healthcare provides comprehensive credentialing services, including primary source verification, CAQH enrollment management, insurance network enrollment with major carriers (Aetna, UnitedHealthcare, BlueCross BlueShield), hospital credentialing support, and ongoing re-credentialing management. They maintain updated NPI records and ensure your surgeon profile information stays current across all platforms. 

Key Benefits for Surgery Practices 

Credex Healthcare excels at managing complex surgical credentialing scenarios. If you’re a surgeon with privileges at multiple hospitals or surgical centers, they handle coordination across all practice locations. Their team understands the nuances of surgical privileges—they know that orthopedic surgeons need different credentialing than vascular surgeons, and they tailor their approach accordingly. 

Their technology tool lets you track things clearly, so you always know exactly about the status of your credentialing application. Their ongoing contact with credentialing groups at big hospitals often speeds up the hospital privileging process. Most importantly, they proactively follow up on pending applications, preventing the common scenario where applications get stuck waiting for documentation. 

Credex Healthcare offers quick credentialing services to healthcare companies that want a speedy solution. Their workflows maintain the accuracy of the process while also ensuring fast turnaround time. 

Practolytics 

Practolytics provides full credentialing and practice management integration to surgery offices.  Practolytics handles all standard credentialing services for surgeons and works with practice management systems. When a new surgeon comes to work at your practice, Practolytics’ software fetches its credentials for your hiring needs to reduce manual data entry errors. 

They are good at handling multi-payer settings. These days, surgeons work with dozens of insurance companies, each with their own set of rules. Practolytics knows how to handle these details in a planned way. Their services are best suited to the practices that work with existing practice management systems. 

Cigna 

Cigna is widely known as an insurance provider, but it also helps healthcare workers get into insurance networks by helping them get credentials. Cigna directly helps with credentialing, which can streamline the process for surgeons wanting to contract with insurance networks. 

If you work directly with Cigna, you can speed up your credentialing process. However, you will still need additional credentialing support for other insurance companies and hospital networks. Their services are best for surgeons in markets where Cigna represents significant insurance volume. 

MedCare MSO 

As part of their wider assistance for medical services organizations, MedCare MSO provides credentialing services to private surgery practices with things like billing, credentialing, and licensing. MedCare MSO can manage credentials for doctors who work at multiple clinics or surgery centers. 

Their team knows exactly what kinds of paperwork different surgery fields and insurance companies need. It is best for multi-location surgical practices needing coordinated credentialing management. 

Precision Practice Management 

Precision Practice Management offers credentialing services designed for surgery and procedure experts. Their team includes professionals with healthcare administration backgrounds who understand practice operations. They offer expedited credentialing options for surgeons who need faster turnaround. 

Their experience with surgical practices means they anticipate common credentialing roadblocks and work proactively to prevent delays. It is a good credentialing company for surgeons who care most about speed and want to work with people experienced in medical practice. 

Dastify Solutions 

Dastify Solutions focuses on tech-based solutions while providing healthcare credentialing services. Their platform is based on easy-to-use tools and open tracking. For surgeons uncomfortable with technology or lacking dedicated administrative staff, Dastify’s simple platform makes credentialing management accessible. 

They give regular reports on the state of their system so that practices do not have to check it all the time. Tech-savvy practices that want a new, easy-to-use credentialing tool can benefit from their services. 

iRCM 

iRCM’s focus is on credentialing and revenue cycle management for surgery and other routine practices. They know that credentialing has a direct effect on your revenue cycle, so they combine credentials management with overall billing efficiency. 

If your practice has a hard time with claim rejections, delayed reimbursements, and problems with credentialing, iRCM can help. Through fixing problems with credentialing, they figure out why claims are rejected. Their credentialing services are best for surgeons with complex billing issues requiring integrated revenue cycle and credentialing solutions. 

Knack RCM 

Knack RCM offers revenue cycle management with integrated credentialing services. Their system blends extensive verification solutions with billing efficiency while knowing that these functions are linked. Knack RCM offers more than just simple credentialing to help practices do better financially. 

They analyze your claims data to identify credentialing gaps that might be causing denials. It is best for practices seeking comprehensive revenue cycle solutions with credentialing integration. 

Modio Health 

Modio Health provides credentialing and healthcare management services specifically designed to meet the requirements of independent surgery practices. They focus on surgeons seeking alternatives to employment models while maintaining administrative support. 

CAQH management, insurance registration, and hospital credentialing coordination are all parts of their credentialing services. They keep in touch with hospitals and insurance companies, which speeds up the approval process most of the time. 

MBW RCM 

MBW RCM’s revenue cycle management services include credentialing, billing, and licensing. Their team includes professionals experienced with surgical practices and procedural centers. 

They know that surgery licensing means doing a lot of paperwork and working with a lot of different people. MBW RCM handles this difficult task and keeps your practice updated at all times. It is best for surgeons who want a full revenue cycle system that includes credentialing at its core. 

Choose the Right Credentialing Company for Surgeon Credentialing 

There are a lot of credentialing partners to choose from, so it’s important to consider the following points: 

Experience with Surgical Practices 

Find companies that have been known to give credentials to providers in your field. Get recommendations from surgeons who have already obtained their credentials. Ask if they have experience with surgical practices. 

Turnaround Time 

Ask potential companies how long it takes them on average to process applications and how many applications they process in that time. 

Technology and Transparency 

Evaluate their technology and how transparent they are. Your credentialing company should provide online portals showing real-time application status to keep you aware of each application. 

Cost Structure 

Find out how much it will cost for credentialing services from your chosen company. Stay away from practices that charge additional prices. Know their basic service and what you are paying for. 

Compliance and Security 

Make sure that the company you use for credentialing follows HIPAA, handles data securely, and knows the state and federal rules that affect medical credentialing. 

Payer Relationships 

Companies having a good relationship with major insurance companies like Aetna, UnitedHealthcare, BlueCross BlueShield, and various hospital systems. 

Customer Support 

You should choose a company that is familiar with specialty-specific knowledge and is quick to respond. All their customer service centers maintain positive reviews and ratings.  

Conclusion 

Credentialing can slow down your medical practice, but it doesn’t have to. If you work with the right credentialing company, you can turn this difficult paperwork into an easy process. 

There are many things to consider when choosing a credentialing partner for your practice. Do you work at one hospital or at multiple facilities? Do you experience billing problems that go beyond credentialing? Do you need help with technology integration? Are you the only surgeon at your practice, or do you manage multiple surgeons? 

While choosing a company, do not immediately jump towards the cheapest option. The least expensive choice usually takes the longest or requires you to follow up too much. Instead, find a partner who knows about surgery practices, credentialing, provides fast credentialing with the highest first-time submission success rates. The credentialing company should provide you with real-time insight about your application status. Credex Healthcare streamlines surgeon credentialing and has a 99% first-time application success rate through its customized credentialing solution. 

Frequently Asked Questions 

How long does surgeon credentialing take? 

It usually takes 60 to 120 days for standard credentialing from submitting your application to getting you credentialed. The timeline depends on how complete the application is, how quickly the insurance company responds, and whether your surgeon’s credentials match with corresponding documentation. 

Do I need credentialing for each insurance company separately? 

Yes. However, these days, most insurance companies use CAQH registration, which collects all credentialing data in one platform. When you sign up for CAQH, a lot of insurance companies can check your credentials in the database instead of asking you to apply for them each time. 

Can a credentialing company handle multiple states’ surgeon credentialing? 

Absolutely. Most of the time, professional credentialing services work across the country, expecting to know what each state’s medical board needs. Choose a company that has worked in multiple states if you have doctors in more than one practice location. 

What documents are required for surgeon credentialing? 

The required documents for surgeon credentialing include a medical license, medical school diploma, residency training certificates, board certification from a specialty board such as the American Board of Surgery, DEA registration, National Provider Identifier (NPI), malpractice history, proof of liability insurance, employment history, and letters of recommendation from hospital colleagues. 

How much does surgeon credentialing cost? 

The cost of credentialing varies from $500 to $3,000 for each provider, based on how complicated it is and what services are included. It usually costs an extra $200 to $500 per hospital for hospital privileging, $50 to $150 for CAQH registration, and 20% to 40% more than the base cost for expedited processing.