Best Medical Credentialing Companies for Rheumatology 

The demand for rheumatology services increased due to the spread of more autoimmune conditions across the United States. Due to this, rheumatology practices need to deal with these challenges professionally to get credentialed quickly and efficiently. The credentialing process is a critical step that determines when a provider can start treating patients and receiving reimbursements. 

Due to the unique requirements of rheumatology credentialing, partnering with expert and specialty-focused credentialing companies is essential. There are many medical credentialing companies for rheumatology that are experts in specialized procedure codes of biologic medication coverage and specialty inside and out. The right credentialing company can help you start your practice quickly and get the reimbursement to optimize your revenue cycle.  

What Is Rheumatology Credentialing? 

Rheumatology credentialing is the process of verifying a rheumatologist’s credentials, such as education, training, and professional background, so that they may participate in insurance networks. This includes measures like primary source verification of medical qualifications and job history, with most insurance companies relying heavily on the CAQH ProView database. 

Rheumatologists need to keep their CAQH profiles up to date for commercial payer applications. They also need to handle Medicare and Medicaid enrollment through PECOS, which requires more paperwork. Every credentialing application requires a unique National Provider Identifier (NPI). Additionally, rheumatology clinics must properly convey their specific procedures and treatments to prevent claim rejections and payment delays. 

Why Rheumatology Practices Need Specialized Credentialing 

• Complex Treatment Protocols: Rheumatology involves sophisticated treatment protocols that include biologic medications, infusion therapies, and specialized diagnostic procedures.  

• High-Cost Medications: Many rheumatology treatments involve high-cost specialty medications that require prior authorization and specific billing procedures.  

• Multiple Payer Requirements: Rheumatologists often work with a wider range of insurance payers than many other specialties because autoimmune conditions affect patients across all demographics. 

• State Medical Board Regulations: Each state has specific regulations for rheumatology practice, particularly around controlled substances for pain management and the administration of biologic therapies. 

• Ongoing Recredentialing: Insurance companies require recredentialing every 2–3 years, and any changes to your practice, new locations, additional providers, or expanded services require recredentialing.  

Best Medical Credentialing Companies for Rheumatology 

Following are the best medical credentialing companies for rheumatology in the US.  

1) Credex Healthcare 

Credex Healthcare is a leading medical credentialing company in the United States, with extensive experience serving specialty practices, including rheumatology. Based in Florida, Credex offers comprehensive credentialing services from initial applications through ongoing recredentialing. 

Credex Healthcare always has a personalized approach with dedicated specialists for each client. This customized solution ensures streamlining the process for rheumatologists dealing with complex autoimmune cases and high-cost medications. They handle all major payers, including Medicare, Medicaid, and top commercial insurers.  

They also manage CAQH profile creation and maintenance. Their experience with rheumatology-specific billing codes and prior authorization requirements makes them particularly valuable for practices that offer infusion services or manage complex medication regimens. 

Turnaround Time: 90-120 days for most commercial payers; 60-90 days for Medicare 
Best For: Solo rheumatologists and small to mid-sized rheumatology clinics looking for personalized service 

2) Physician Practice Specialists (PPS) 

Physician Practice Specialists (PPS) specializes in credentialing, contracting, and consulting services for experienced rheumatologists starting or expanding practices. With experience in credentialing over 50,000 providers and initiating more than 5,000 private practices nationwide, PPS fully understands state-specific credentialing variations.  

They assist with insurance paneling, contract negotiations, hospital privileging, and telemedicine credentialing. PPS also provides expertise in negotiating favorable reimbursement rates for specialty procedures essential for enhancing revenue. The average turnaround time for their services is 90-120 days, making them ideal for new rheumatology practices and established clinics expanding to new states. 

3) MediBillMD 

MediBillMD provides credentialing services across more than 45 medical specialties, including rheumatology. Their pricing model is percentage-based, which can be particularly advantageous for practices that may have limited cash flow. The company is both HIPAA-compliant and ISO-certified.  

They handle documentation and negotiate contracts with major payers through a systematic approach to minimize delays and errors. They aim for a turnaround time of 90 to 120 days for commercial payers. The waiting period makes it a perfect fit for rheumatology practices that prefer this pricing model. 

4) Capline Healthcare Management 

Capline Healthcare Management has been there for healthcare workers since 2016. They handle income processes for over 650 businesses. Their certification options are made to meet the needs of rheumatology offices. There are no secret fees for their service, which includes making insurance websites and keeping personal data up to date. Capline knows a lot about specialty groups.   

Their follow-up method is both orderly and effective, which helps them handle applications easily. In most cases, it takes between 90 and 120 days to turn around. Because of this feature, they are a fantastic choice for rheumatology offices that need full help with the income cycle and licensing. 

5) Practolytics 

Practolytics provides a technology-driven solution for medical credentialing. They support more than 1,400 providers, spanning over 28 specialties. They offer credentialing pathways that are specific to each specialty. This approach considers the unique needs of rheumatologists, setting them apart from other fields.  

Practolytics also takes care of important tasks, such as getting approvals for biologic medications and collecting medical records from other places Most payers usually have a turnaround time of about 90 to 120 days. It is a beneficial choice for rheumatology practices that are tech-savvy and looking for integrated solutions in credentialing and revenue cycle management. 

6) CureMD 

CureMD specializes in medical credentialing, significantly reducing timelines from months to weeks. Their services encompass enrollment in government and commercial insurance programs, NPI registration, and CAQH profile management.  

Rheumatologists can use their help keeping licenses and certifications up to date, and they also help with recredentialing every two to three years. CureMD’s organized method makes sure that they talk to insurance companies ahead of time, which speeds up the licensing process even more. 

7) National Credentialing Solutions (nCred) 

National Credentialing Solutions has a one-of-a-kind credentialing platform. You may see how your application is doing in real time on this platform. They provide services in various areas of medicine across the nation. The package includes managing applications, keeping CAQH profiles up to date, signing up for Medicare and Medicaid, and obtaining credentials from commercial payers.  

The tech-savvy people in their plan make things more efficient. They also make sure that insurance companies always get follow-ups and those providers are kept in the loop. They are a wonderful way for rheumatologists who always want to know how they are doing with their credentials to keep an eye on their state. 

8) Credentialing.com 

Credentialing.com provides billing and credentialing services for medical professionals. They work with over 8,000 customers around the country, mostly rheumatology clinics. Each project has a team of professionals that work on it full-time. This method guarantees individualized service and increases productivity.  

 There are no hidden costs; you only pay for the credentialing tasks that are completed. The normal time it takes to get things done is between 90 and 120 days. This makes them a great alternative for clinics that want a credentialing solution led by a doctor without having to worry about any unforeseen fees.  

 
9) MedCare MSO  

MedCare MSO’s main job is to accredit and enroll healthcare professionals. They have a 95% success rate, which is quite high. They check primary sources and help in payer enrollment.  They also keep an eye on credential management at the same time. This means checking expiry dates and ensuring everything is up to code.  

 Rheumatologists will find this service very helpful to prevent mistakes from happening that might affect patient care. They know a lot about complicated specialist practices. This makes them a good alternative for clinics that treat rheumatic disorders.  

10) Verisys 

Verisys stands out as the largest provider of outsourced credentialing. Each year, they handle well over two million credentialing processes. Remarkably, they maintain an accuracy rate of over 99.95% in verifying provider data. They provide scalable solutions tailored for rheumatology practices, regardless of their size, while ensuring compliance with NCQA and URAC standards. Verisys keeps a close eye on credentials and proactively inform providers about any potential issues that may arise.  

Automated verification and real-time updates help reduce claim denials that can happen because of credentialing lapses. Perfect for big rheumatology groups and health systems that focus on speeding up processing by using automation. 

Comparison Table: Top Rheumatology Credentialing Companies 

Company	Specialization	Key Services	Turnaround Time	Pricing Model
Credex Healthcare	Specialty practices	Full credentialing, CAQH, Medicare/Medicaid	60-120 days	Project-based
PPS	Start-ups & contracting	Credentialing, negotiation, consulting	90-120 days	Per-provider
MediBillMD	45+ specialties	Credentialing, billing integration	90-120 days	Percentage-based
Capline	Revenue cycle focus	Credentialing, RCM, billing	90-120 days	Service-based
Practolytics	Technology-driven	Credentialing, RCM, prior auth	90-120 days	Competitive rates
CureMD	Fast processing	Full credentialing suite	Expedited	Custom quotes
nCred	Platform-based	Credentialing with tracking	60-120 days	Software + service
Credentialing.com	Physician-led	Credentialing, billing	90-120 days	Transparent pricing
MedCare MSO	Ongoing monitoring	Credentialing, maintenance	Variable	Service-based
Verisys	Enterprise-scale	Automated verification, monitoring	Accelerated	Enterprise pricing

How to Choose the Right Credentialing Company for Rheumatology 

1. Seek out credentialing companies that have a solid background in specialty practices. It is particularly important to find those who understand rheumatology, autoimmune care, biologic medications, and infusion services. 

2. Ask for specific references to confirm their expertise in rheumatology practices. 

3. Make sure the credentialing company has solid connections with Medicare and different commercial payers. This helps in understanding specific requirements and accelerating the application process. 

4. Choose a company that offers real-time tracking of credentialing applications. Look for those with online portals or regular updates to stay informed about your application status. 

5. Choose a credentialing partner that provides continuous compliance support. This will help you adjust to changing healthcare regulations. It’s essential for safeguarding against claim denials and potential legal problems. 

Cost of Rheumatology Credentialing Services 

Credentialing costs generally break down into two main types: the one-time credentialing fees and ongoing maintenance expenses. 

One-Time vs Ongoing Costs  

The initial costs for credentialing with one insurance payer usually fall between $200 and $500. On the other hand, Medicare credentialing tends to be more affordable, generally ranging from $150 to $300. Rheumatologists typically need to get credentialed with around 10 to 15 payers. This process can lead to initial costs that range from $2,000 all the way up to $7,500.  

Ongoing expenses for maintaining a CAQH profile typically range from $50 to $100 each month. The cost of recredentialing typically falls between $150 and $300. This process usually occurs every two to three years.   

Pricing Factors

The price of getting credentials in rheumatic practices might be different. For example, the quantity of suppliers and locations is important. Each one needs customized method for getting credentials according to the practice’s specilty. Companies that are professionals may charge more but they may assist in lowering expenses by cutting down on the number of denied claims. 

Outsourcing vs. In-House Comparison

Many rheumatology practices argue about whether to do credentialing in-house or outsource it. While in-house credentialing looks like the less expensive option, it comes with many related costs. It can also cause application delays by inexperienced staff and can have a negative impact on provider’s practice.  

On the other hand, outsourcing costs $3,000 to $10,000 a year for each provider. This leads to faster credentialing, fewer claim rejections, and staff members being able to focus on patient care. When accounting for all the hidden costs, outsourcing typically results in greater financial savings. 

FAQs 

How long does rheumatology credentialing take? 
Credentialing times range from 90 to 120 days for commercial payers and 60 to 90 days for Medicare. However, some specialty credentialing companies can accelerate this process. 

Do rheumatologists require separate Medicare enrollment? 

Yes, Medicare enrollment requires a separate application through PECOS (Provider Enrollment, Chain, and Ownership System) because it is different from commercial payer credentialing. 

How often does recredentialing occur? 

To ensure providers’ credentials are up-to-date and valid, most insurance companies require recredentialing every 2–3 years. 

Can credentialing companies handle multi-state practices? 

Yes, professional credentialing companies like Credex Healthcare can handle multi-state practice applications at the same time, as their experts are fully aware of each state’s unique rules to ensure compliance.  

What documents are required for rheumatology credentialing? 

You’ll need your medical license, DEA certificate, board certification, CV, malpractice insurance, NPI number, medical school diploma, residency/fellowship certificates, and work history. 

Conclusion 

Choosing the right credentialing company can have a big effect on how well your rheumatology practice performs. Partnering with professional rheumatologists and credentialing companies can get you licensed faster and avoid expensive claim rejections. 

Whether you are a solo rheumatologist just starting your own practice or in charge of a big clinic with lots of providers, using a professional credentialing service saves you time and makes you stress-free. However, choosing the right partner is important, one that understands the specific needs of a rheumatology practice. Credex Healthcare offers customized end-to-end credentialing services from initial credentialing application submission to approval and renewal. Our experts keep real-time track of the application to handle all the issues before they arise.   

Contact the rheumatology credentialing specialists today to streamline credentialing, reduce reimbursement delays, and maintain compliance with insurer requirements.