Best Credentialing Companies for Pharmacists 

The step of credentialing is essential to pharmacists and pharmacy owners to complete the internal audit of their adherence to insurance and PBM requirements, access to clinical services such as immunizations, as well as to access to Medicare/Medicaid programs. The appropriate credentialing companion can save time, minimize errors, and expedite your admission to benefits organizations. 

Everything that you need to know about pharmacist credentialing is discussed below, beginning with the top credentialing companies (topped by Credex Healthcare) and their services, strengths, and website links. Pricing, benefits, and Frequently Asked Questions are also explained on the basis of this guide. 

Why Pharmacists Need Credentialing Services 

Pharmacists are not just medication dispensers anymore; most of them offer immunizations, administration of medication therapy, and other clinical services. Credentialing is required to be able to bill and participate in PBM and insurance networks legally. 

The main justifications of pharmacist credentialing are: 

• PBM Enrollment: To fill insurance plans and be reimbursable using networks, such as OptumRx, Express Scripts, or CVS Caremark. 

• Clinical Services: Immunizations, medication management, and specialty services can also be credentialed. 

• Compliance: Makes sure that the regulations are followed by NABP, CMS, and state pharmacy boards. 

• Medicare/Medicaid Programs:): Part B, Part D, and state Medicaid pharmacy programs must be credentialed to bill. 

Credentialing outsourcing helps to release the pharmacists and staff so that they can concentrate on the patients and not on administration. 

What Does a Pharmacist Credentialing Companies Do? 

Professional credentialing companies handle all of the enrollment and verification: 

• NPI & CAQH Registry: Records NPI numbers and profiles CAQH ProView. 

• PBM Contracting: Processes PBM applications with large PBMs (OptumRx, Express Scripts, CVS Caremark) and insurance plans. 

• Medicare/ Medicaid Enrollment: This helps in the provider enrolment process of Medicare Part D, Part B, and state Medicaid pharmacy enrolment. 

• Credentialing of Clinical Privileges: Dental immunization certification, clinical services credentials, and advanced pharmacy practice credentials. 

• Documentation Management: Secures, copies, and forwards necessary documentation to the payers, minimizing mistakes and time losses. 

Key Qualities of the Best Credentialing Companies for Pharmacists 

In selecting a credentialing company, one should consider: 

• Expertise in PBM and pharmacy credentialing. 

• Excellent knowledge of CMS, NABP, and state boards compliance. 

• Live tracking of the status and reporting. 

• Low costs and open charges. 

• Independent pharmacy, retail, and clinical pharmacy service experience. 

Top 10 Best Credentialing Companies for Pharmacists 

The following is a selective list of the 10 best credentialing firms, with Credex Healthcare topping the list: 

1. Credex Healthcare 

Overview: 

Credex Healthcare offers universal credentialing services to pharmacists and pharmacies, such as CAQH setup, NPI setup, PBM setup, Medicare/Medicaid setup, and re-credentialing. They also have clinical pharmacy operations supported by their team, including immunizations and MTM service credentialing. 

Strengths for Pharmacists: 

• Bi-monthly pharmacy credentialing experts. 

• Experience in the key PBMs: Express Scripts, OptumRx, CVS Caremark. 

• End-to-end follow-up and enrollment. 

• Monitoring of compliance and maintaining credentials. 

• Personalized services to independent, retail, and clinical pharmacy arrangements. 

2. Medversant 

Overview: 

Medversant is a CVO (NCQA-accredited) offering CVO services in credentialing and provider enrolment of healthcare providers, as well as pharmacists. They focus on primary-source authentication, document administration, and credential tracking. 

Strengths for Pharmacists: 

• Credentialing management platform- It refers to an automated system that supports credentialing processes. 

• Granting licenses and certifications: constant supervision. 

• Specialisation in Medicare, Medicaid, and commercial PBMs. 

• There are high compliance requirements in clinical pharmacy operations. 

3. Vālenz Health 

Overview: 

V Airlines Health provides services of credentialing verification, such as primary-source verification, credential monitoring, and provider enrollment. Their VPoint platform assists them in monitoring real-time application advancement and expiry warnings. 

Strengths for Pharmacists: 

• URAC-accredited CVO 

• Quick response and less time to approve. 

• Automated license, DEA, and CAQH expirations. 

• Favors multiple location pharmacy systems and clinical pharmacists. 

4. nCred / National Credentialing Solutions. 

Overview: 

Enhancing provider enrollment and credentialing through a broad spectrum of healthcare providers, such as pharmacists, is the business emphasis of nCred. They offer the CAQH management, PBM enrollment services, and credits lifecycle management. 

Strengths for Pharmacists: 

• Mintpocket credentialing experienced personnel. 

• Smoother process to expedite the application process. 

• Standardized and harmonized work processes that minimize inconsistency. 

• Re-credentialing and maintenance of CAQH are involved. 

5. Symplr Credentialing Suite 

Overview: 

Symplr offers health care credentialing and compliance management at an enterprise level to healthcare providers, which include pharmacists. They are compatible with CAQH, PBM enrollment, Medicare/Medicaid, as well as continued credential monitoring. 

Strengths for Pharmacists: 

• All-inclusive credentialing software + service system. 

• Constant checking of licenses, sanctions, and credentials. 

• Multi-location network and multi-site independent pharmacies. 

• Connectivity with billing and compliance systems. 

6. Fifth Avenue Credentialing Network (5ACVO)

Overview: 

5ACVO is an enrollee in provider and credentialing services, dealing with various payer networks, which include PBMs. Their NCQA-approved procedure follows suitability in the case of pharmacists and pharmacies. 

Strengths for Pharmacists: 

• Single point of entry for a number of payers. 

• Eliminates duplicate tasks and accelerates the approval process. 

• Assists in the pharmacy networks and independent providers. 

• The primary source verification/re-credentialing services. 

7. Physician Credentialing Company

Overview: 

The services that this firm offers include CAQH enrollment, PBM contracting, Medicare/Medicaid registration, and primary-source verification. They control follow-ups to make certain that pharmacists and clinical pharmacy teams are approved in time. 

Strengths for Pharmacists: 

• Good account management including weekly follow-ups. 

• Established procedures on CAQH and payer enrollments. 

• Clinical and retail pharmacy credentialing experience. 

• Pharmacists should receive assistance with hospital privileges when they are offering clinical services. 

8. Capline Healthcare Services

Overview: 

Capline specializes in credentialing and enrolling different healthcare providers, such as pharmacists. Their services include PBM credentialing, Medicare Part D, and CAQH management. 

Strengths for Pharmacists: 

• Practiced in both pharmacy and clinical provider credentialing. 

• Transparent flexible pricing models. 

• On-demand credentialing status reporting. 

• Consumers Supporting Single-Location and Multi-Location Pharmacy Practice. 

9. Credentialing.com (previously CVO Solutions) 

Overview: 

Credentialing.com is a complete CVO offering PBM enrollment, Medicare / Medicaid credentialing, and CAQH management. They serve individual pharmacists, as well as pharmacy networks. 

Strengths for Pharmacists: 

• Ultimate commercial and government enrollment. 

• Checking and monitoring compliance of primary sources. 

• Great advocacy of pharmacy credentialing on a clinical basis. 

• Effective document screening and monitoring. 

10. Medicus Healthcare Solutions 

Overview: 

Medicus offers its full provider credentialing encompassing PBM application, CAQH administration, and Medicare/Medicaid enrollment. They provide medical professionals in a variety of fields, including pharmacy. 

Strengths for Pharmacists: 

• In addition to having expertise in clinical pharmacy, they must have expertise in PBM credentialing. 

• Full-time assistance to do paperwork. 

• Constant credential tracking and re-credentialing. 

• Independent, retail, and hospital pharmacies: scalable. 

Benefits of Outsourcing Pharmacist Credentialing 

• Fewer errors: Before documents are submitted, the experts identify the mistakes. 

• Quick approvals: Expert teams accelerate PBM and reimbursement registrations. 

• Compliance insurance: Reduces the chances of penalty or disqualification. 

• Time-saving: Pharmacists are concerned with patient care, clinical service, and pharmacy activities. 

• Scalability: Credentialing companies expand according to your practice, working with a variety of providers and locations. 

How Much Do Pharmacist Credentialing Services Cost? 

Typical fee ranges: 

• CAQH installation and maintenance: $150400 per provider. 

• PBM enrolment: $200-500 per application. 

• Medicare/Medicaid enrollment: $300AKA AKA 700. 

• Re-credentialing: between 150 and 300 dollars per provider. 

• Pricing variables: 

Number of PBMs or payers:

• Credentialing- Also known as the clinical service qualification standards. 

• Multi vs. independent pharmacy. 

• The turnaround time and complexity. 

FAQs 

1. What is the period of PBM credentialing among pharmacists? 

In general, 45 -90 days based on PBM and document completeness. 

2. Will you assist with Part D pharmacy enrollment for Medicare? 

Yes, enrollment of Medicare Part D and Part B is done under most of the credentialing firms, including Credex. 

3. Credentialing of pharmacists: what do you need to do? 

Documents that are most frequently needed: pharmacy license, NPI, DEA license (where necessary), immunization certification, malpractice insurance, CV, tax ID, and CAQH profile. 

4. Do you believe in independent and retail pharmacies? 

No, credentialing is offered to independent pharmacies, retail chains, and clinical pharmacists by all the top 10 firms. 

5. Are you also involved with CAQH for the pharmacists? 

Credentialing companies, yes, deal with the setup of CAQH ProView, maintenance, and attestations of pharmacy providers. 

Final Thoughts 

A very important business choice is to select the most appropriate credentialing companies for pharmacists. An effective vendor does not just make sure it complies, but also helps in shortening the access to PBM networks, Medicare/Medicaid programs, and clinical service credentialing.