Best Credentialing Companies for Multi-Specialty Practices

It’s like juggling dozens of balls at once when it comes to managing credentials across several medical specialties. Every payer, every region, and every provider has different needs. Your multispecialty practice runs the risk of delays, patient attrition, and compliance problems if you don’t have the right credentialing services. This blog highlights the best credentialing companies for multi-specialty practices. 

The Complexity of Multi-Specialty Credentialing 

Multi-specialty practices operate in a different universe than single-specialty clinics. Here’s why: 

Multiple Provider Taxonomies 

Every medical specialty has a unique taxonomy code. A pediatrician or dermatologist must have different credentials from an orthopedic surgeon. Payers are aware of these variations and require proof unique to a specialty. Weeks may pass before enrollment is completed if even one taxonomy code is missed. 

Multiple NPIs and Provider Types 

Individual NPIs (Type 1 for providers) and group NPIs (Type 2 for your organization) are probably necessary for your practice. Medicare, Medicaid, and Managed Care Organizations all have varying NPI requirements. Without the right systems, managing this across 20 suppliers becomes onerous. 

Different Payer Networks 

Numerous insurance companies frequently enter into contracts with multispecialty practices. Every payer has different paperwork requirements, verification procedures, and timelines for credentialing. Cigna and Aetna have different enrolment processes, therefore what works for Aetna will not work for Cigna. 

Multi-State Operations 

Running clinics in multiple states multiplies your credentialing challenges. Verification of licensing takes longer, state medical boards have various criteria, and some payers only accept credentials from particular states. It is practically difficult to manage state-by-state compliance without assistance. 

CAQH Setup for Multiple Providers 

Credentialing is made easier by the Council for Affordable Quality Healthcare (CAQH) using a centralised database. However, it takes regular attention and updates every 60 days to set up and manage CAQH profiles for numerous providers. 

Complex Contracting Management 

It takes specialized resources to negotiate contracts with several payers, schedule revalidations on time, and update credentials throughout your provider network. A provider may be removed from entire insurance panels for failing to meet a revalidation deadline. 

Top Credentialing Companies for Multi-Specialty Practices 

1. Credex Healthcare 

Leading the way in credentialing solutions for multispecialty practices is Credex Healthcare. Having worked in healthcare credentialing for more than 15 years, Credex is an expert at overseeing intricate provider networks with several locations and specialties. 

Credex Healthcare is very good at managing practices with more than ten providers in many medical specialties. Their automated CAQH administration keeps your practice compliant by updating all provider data every sixty days without the need for human interaction. By managing Medicare, Medicaid, and commercial payer enrollments concurrently, they shorten the usual credentialing period from six to twelve months to three to four months. 

Key Features 

1. Automated CAQH updates across multiple providers 
2. Dedicated account managers for large practices 
3. Multi-state licensing verification in under 30 days 
4. Real-time enrollment tracking dashboard 
5. Managed Care Organization contract negotiations 
6. Management of NPI Type 1 and Type 2 is included. 
7. Revalidation scheduling is automated 90 days before expiration. 

Best For 

Large multi-specialty groups, hospital-owned practices, and federally qualified health centers managing diverse provider networks. 

2. CureMD 

Credentialing is integrated with practice management and EHR systems by CureMD, a cloud-based healthcare IT platform. They have streamlined operations for more than 2,000 practices. 

Integration is CureMD’s strongest suit. Your credentialing information immediately synchronizes with patient records, scheduling, and billing. Any changes made to a provider’s credentials are reflected throughout your system. This lowers administrative errors and gets rid of data silos. 

It is best for tech-forward practices that oversee five to thirty providers seek integrated credentialing with their practice management system. 

3. Capline Healthcare Management 

Capline Healthcare Management is solely concerned with group practice enrolment and certification. In the US, they oversee the certification of more than 3,000 clinicians. 

Swiftness is Capline’s area of expertise. To reduce red tape, they have streamlined the credentialing procedure. Their major payer enrolment credentialing process takes an average of two to three months, which is substantially shorter than industry norms. Along with payer enrolment, they manage hospital privileging, resulting in a complete credentialing solution. 

It suits best for hospital-integrated clinics, practices opening new locations, and multispecialty offices seeking quick enrolment times. 

4. Practolytics 

Practolytics offers healthcare organizations analytics, business intelligence, and credentialing services. They cater to practices with 10–500+ providers. 

Practolytics offers real-time insights into your enrollment status, payer contract details, and income potential in addition to credentialing. Their analytics technology helps you find revenue leaks and enrollment gaps by displaying which payers have enrolled certain providers. 

It is good for large groups evaluating provider performance across payer networks, clinics maximizing enrollment ROI, and practices seeking credentialing data linked to revenue insights. 

5. Verisys 

Verisys is an expert in primary source verification and healthcare credentialing for big provider networks. More than 50,000 suppliers have received their credentials. Primary source verification, the foundation of authentic credentialing, is where Verisys shines.  

They shorten verification times by keeping close ties with hospitals, licensing authorities, and medical schools. The entire credentialing process, from document collecting to final payer enrolment, is streamlined by their technological platform. Its services are good for large healthcare systems, hospital networks, practices with 20+ providers, and clinics prioritizing verification speed. 

6. nCred 

For small to mid-sized multispecialty practices, nCred is a cloud-based credentialing tool. its reputation has been established by its cost and ease of use. Credentialing is made simpler using nCred. Their technology removes confusion by guiding your employees through the credentialing process step-by-step.  

Additionally, they provide flat-rate pricing, so regardless of the intricacy of your credentials, you know precisely how much you’ll pay. It is ideal for clinics that are new to formal credentialing procedures, small to mid-sized multispecialty practices (5–20 doctors), and practices seeking predictable credentialing costs. 

7. MBW RCM 

One of the main services provided by MBW RCM is revenue cycle management with credentialing. They oversee the invoicing and certification of more than 1,500 clinicians in various specialties. MBW RCM delivers a comprehensive strategy, managing your revenue cycle and handling credentials at the same time. This implies that problems with credentialing are identified before they affect billing.  

Early enrolment gaps are identified, and efforts are made to fix them before claims are rejected. Clinics seeking smooth workflows from credentialing to billing and having trouble collecting payments can use its services. It is also good for multispecialty practices seeking integrated credentialing and revenue cycle management  

8. Denmaar 

Credentialing for dentistry, medical, and mental health practices is Denmaar’s area of expertise. Their medical credentialing services for multispecialty offices are extensive and expanding, despite their dental specialization. Denmaar easily manages credentials for all three specialties if your multispecialty clinic offers behavioral health or dentistry services.  

They are aware of specialized certification requirements that are disregarded by conventional medical certification firms. It is good for clinics catering to various patient demographics, integrated healthcare systems, and multispecialty practices like dental or behavioral health. 

9. AMS Healthcare Solutions 

For healthcare organizations, AMS Healthcare Solutions offers practice management consultancy in addition to credentialing services. They have assisted in the management of more than fifty providers. AMS integrates practice management consulting with credentialing knowledge. They find efficiency gains and optimize your entire credentialing process, not simply enrolling providers.  

Their advisory approach aids practices in avoiding credentialing issues in the future. It is ideal for multi-specialty practices wanting certification paired with operational optimization, increasing healthcare organizations, practices suffering credentialing difficulties. 

10. Transcure 

Transcure provides mid-to-large medical groups with healthcare IT services and credentialing. They have certified practitioners in several states in every main specialty. When it comes to multi-location, multi-state credentialing, Transcure is good. Their software lowers compliance risks by automatically managing state-specific standards. Additionally, they provide internal staff with credentialing training, which enhances organizational capabilities. 

It is best for healthcare systems that need to integrate IT and credentialing, organizations looking to develop internal credentialing capabilities, and multi-location practices across several states.  

Credentialing Workflow for Multi-Specialty Clinics 

Understanding the credentialing process helps you choose the right partner: 

NPI Assignment 

Each provider must have a unique NPI (Type 1). An organizational NPI (Type 2) is required for your practice. The National Provider Identifier system is used by credentialing firms to get NPIs. 

CAQH Setup 

Payers can obtain provider data centrally through CAQH. CAQH profiles should be created by your credentialing partner and updated every 60 days. By doing this, data conflicts between payer networks are avoided. 

Payer Enrollment 

Every insurance plan you wish to sign a contract with receives applications from your credentialing business. This covers commercial payers as well as Medicare and Medicaid. Depending on the payer and the quality of the documents, timelines can range from two to six months. 

Hospital Privileging 

Providers require hospital qualifications and privileges if your multispecialty practice admits patients to hospitals. This entails distinct applications, background investigations, and peer review procedures carried out by hospital credentialing committees. 

Contracting 

Once credentialed, your company negotiates contracts with payers. Your credentialing partner should handle contract review and negotiation alongside enrollment. 

Revalidation Schedule 

Every two to three years, the majority of payers want revalidation. Ninety days before to expiration, your credentialing company should automatically start revalidation by keeping track of these deadlines. 

Cost of Multi-Specialty Credentialing Services 

Per-Provider Cost 

Depending on the specialty and level of intricacy, standard credentialing fees for providers range from $250 to 600. Costs are increased by faster timescales and primary source verification. 

Group Discounts 

The majority of credentialing organizations give practices with ten or more providers a discount. Instead of $300–600 per provider, you may pay $200–400. 

Panel Enrollment Fees 

Certain businesses impose extra costs for expedited processing or particular payer enrolments. Budget between $50 and $200 for each large payer enrolment. 

Annual Maintenance 

After initial credentialing, maintenance and revalidation usually cost $100 to $250 per provider every year. 

Key Considerations When Choosing a Credentialing Company 

Specialties Supported: Verify that the business has the credentials for your particular specialties. Not all businesses treat credentials in optometry, podiatry, or psychiatry in the same way. 

Geographic Coverage: Partners having in-depth understanding of various state regulatory standards are essential for multi-state practices. Check to see if they have experience in your states. 

Technology Integration: Check if they integrate with your practice management system. Errors and redundant data entry are decreased via seamless integration. 

Revalidation Management: Missed deadlines are avoided using automatic revalidation scheduling. Verify that they have an automated revalidation process 

Communication and Reporting: 

You should have real-time access to your enrolment status. Seek out companies who provide regular status updates and online dashboards. 

Customer Support: 

You’ll need responsive support when issues arise. Ask about assistance availability and typical response times. 

Final Thoughts 

Credentialing for multispecialty practices requires systems, knowledge, and meticulousness. Credex Healthcare is the industry leader in multi-payer enrollment and automated CAQH management. Before making a final decision about credentialing partner, inquire about their experience with the states and specialties you have in mind. Check their revalidation procedures and automation capabilities.  

While you concentrate on patient care, the ideal credentialing partner manages complexity as an extension of your practice. Faster provider enrollment, fewer claim denials due to enrollment gaps, and more compliance confidence are all benefits of investing in professional credentialing services. Do not let credentialing complexity slow your multi-specialty practice growth. 

FAQs 

What is multi-specialty credentialing? 

Verifying and enrolling numerous healthcare providers in various medical specialties with insurance companies, hospitals, and regulatory agencies at the same time is known as multi-specialty credentialing. 

How long does credentialing take for group practices? 

Usually, first credentialing takes three to six months. This can be shortened to two to three months with expedited services. When revalidation is initiated early, it typically takes 4–8 weeks. 

How do you manage CAQH for multiple providers? 

Every 60 days, all provider profiles are updated automatically by CAQH management without human involvement. Select credentialing firms that provide automation for CAQH. 

Do multi-specialty practices need separate NPIs? 

Yes. A unique NPI (Type 1) is required for each supplier. A distinct group NPI (Type 2) is required for your practice organization.