Provider Enrollment services for
Insurance Credentialing Services
The medical world is complicated – add in financials, and everything just got a whole lot trickier. Whether you’re a small private practice, a well-established healthcare facility, or even an upscale speciality healthcare provider, insurance credentialing is a crucial hurdle to tackle before you can even think about entering into your next revenue cycle.
First things first, what exactly is insurance credentialing? And what does it have to do with the healthcare industry? Simply put, insurance credentialing is the act of aligning your medical practice with insurance companies in order to allow your practice to accept third party reimbursement. This not only allows healthcare facilities to serve patients operating under certain insurance plans, but it also opens them up to a broader patient segment by pitting themselves with certain campuses and companies that follow their chosen insurance companies.
Credentialing with Insurance Networks
One thing that makes a healthcare practice shine in today’s landscape is the ability to welcome potential and current patients’ insurance plans. Not only does this place your medical practice on the list of go-to providers, but it also opens up your services to a much larger customer segment, helping you grow. Popular with medical insurance companies, this process, known as provider insurance credentialing or health insurance credentialing, makes them accessible for healthcare practices by allowing them to join their provider panels. Similarly, if a healthcare practice or facility wishes to charge an insurance company as their in-network provider, they must also partake in the credentialing process.
At Credex healthcare
we ensure that your applications are completed in record time for Medicare, Medicaid, Aetna, Cigna, United Healthcare, Tricare, Humana, Blue Cross Blue Shield and several other providers. Curious about our role during the credentialing journey? Here’s a brief breakdown.
Network Research
Application Filing
Application Follow-Up
Appeals for Closed Panels
Out of Network Enrollments
Demographic Changes
Annual Credentialing Maintenance
PECOS AND CAQH SET UP AND MAINTENANCE
Our Add On Services
Our consultants are trained to guide practice managers to ensure that they are performing administrative work to the best of their ability. We use our expertise to help you run an efficient practice by resolving medical practice issues, designing customized strategic business and capital plans, and reducing stress for the provider and staff by implementing a systematic workflow and helping our clients out in managing value-added services. Our experts connect with you and each other to help you achieve your practice management goals.
We offer the following
- Obtaining and maintaining Type 1 and Type 2 NPI numbers
- Registering and updating Identity & Access Management System (I&A) users
- Creating and updating ADA, CAQH, and PECOS credentialing portals
- Provider revalidation and licensing
- Primary source verification
- Negotiating fee schedules and insurance contract rates
- Completing and submitting applications for EFT and ERA setup
- Tracking expiration dates for medical licenses, DEA/CDS, board certifications, CEUs, and other important documents
- DMEPOS enrollment
- Lab credentialing and enrollment
- Telemedicine credentialing and enrollment
- Hospital privileges setup
And much more. Just let us know what you need, and we’ll be there to help you!
WE AT CREDEX HEALTHCARE CAN PROVIDE UNMATCHED CONTRACT RATES AND THE FASTEST TURNAROUND TIME – ALL YOU NEED TO DO IS ASK.
We cover industry segments such as :
Hospitals
Physician Group Practices
Medical Laboratories
Skilled Nursing Facilities
Ambulatory Surgical Centers
Durable Medical Equipment Providers
Home Health Agencies
Tele Radiology / Telehealth
Which Insurance Companies Should I Credential With?
When considering which insurance companies you should be credentialed with, you must look at the major national plans, such as:
• Aetna
• Cigna
• Blue Cross Blue Shield
• UnitedHealthcare
• Humana
• Medicare
• Medicaid
• Tricare
• Anthem
• Highmark
• Carefirst
• Centene Corp
• Kaiser Permanente
• Molina Healthcare, Inc
• UPMC Health Plan
• The Hartford
• Wellcare
However, simply going with the most popular or common insurance companies might not be the best way forward – you also need to determine which firms are of greater value. To do so, you can seek out peer guidance, consult with other practices in your area, and do a deep dive on the insurance firm options available to you to determine which firms most fully meet the requirements of your customer segment.
At Credex Healthcare, we ensure that our clients are provided with the best options. We put in the hours and do extensive research, presenting you with the most efficient, cost-effective, and popular insurance firms for you to consider. Our research passes through multiple markers and fulfills strict criteria, such as your budget, the firm’s reputation, and the top payers. Until you’re satisfied, the iterations continue.
Private Practice and Insurance Credentialing
Private practice can be different from the rest of the medical world, and those establishing one might run into hurdles when it comes to procedures such as charging third-party networks and insurance credentialing.
The first thing in a private practice’s revenue cycle is filing an application for insurance credentialing and earning participating provider contracts for the insurance firms that you’ve decided on. At Credex Healthcare, we complete this process from start to finish, so that you can sit back and relax – and focus on other things in your business! Not only do we handle the process for you, but we also lend guidance as well as information on industry news so that you’re up to date with the revenue cycle workings.
Government Health Programs and Insurance Credentialing
The process of insurance credentialing and provider enrollment take on a different nature for government health programs such as Tricare, Medicaid, and Medicare. Programs such as these often rely on important and accurate information being relayed via forms – forms that once filled are provided to relevant intermediaries who look after the administrative process. At Credex Healthcare, we recognize the importance of government health program enrolment procedures and standards, and we utilize our skills and expertise to make this process as smooth as possible
Insurance Credentialing Process
The insurance credentialing process is not just complicated, it’s also lengthy. Typically, the insurance credentialing process can take months, and what’s more if that not all insurance firms will be looking to align themselves with new providers – so you might not end up getting your best picks the first time around.
Of course, this is exactly what makes outsourcing the insurance credentialing process worth it. By handing over the process to a third-party organization like ourselves, you can rest assured that the right skills and expertise are applied to the process, bumping up your chances of success. At Credex healthcare, we conduct thorough research and years of experience to ensure that payer guidelines are adhered to, including:
Credentialing Phase
During the credentialing part, our team assists you as you submit a request of participation to your select health plans, strictly following their application guidelines. As your application is received, staff members set out to verify your details after which your case is forwarded to the credentialing committee for final approval.
All in all, this journey can take around 90 – 120 business days from start to end. And although this seems like a long waiting period, at Credex Healthcare we provide weekly updates to keep you in loop.
Contracting Phase
Contracting is the next – and final – part of the insurance credentialing process. This part starts after your application has been given a stamp of approval and a contract is sent your way to finalize participation.
At Credex Healthcare, we provide assistance during both the credentialing and contracting phase, and with the latter we lend contracting negotiations prior to finalization, including:
- Language review of your contract of provider participation
- A run through of participation duties
- Securing the best reimbursement rates
With your contract signed, you’ll then be allotted a provider number and effective date after which you can initiate your billing plan and gain reimbursements.
Why Credex Healthcare
Achieve application processing at twice the speed of in-house teams
Transparent, fixed pricing per application—no surprise fees
Full support for your billing team at every step
Real-time tracking of submitted applications
Personalized service with a dedicated account manager
Immediate alerts for upcoming document expirations
Contact Credex Healthcare for credentialing and enrollment services
At Credex Healthcare, we have established a team of skilled and experienced professionals who have spent years polishing their craft in the industry. Our collaborations with both private and public healthcare practices, professional individuals, and various other type of medical facilities run throughout the US. We aim to act as a one-stop solution that provides both enrollment and credentialing services in an efficient, timely, and cost-effective manner.
To learn more about our services and get in touch with our team, you can call us at (833) 477-1261 or write to us at Info@credexhealthcare.com
Specialities we enroll for
Laboratory
Durable Medical Equipment
OBGYN
Urology
Physical Therapy
Cardiology
Orthopedic
Sleep Medicine
Chiropractic
Internal Medicine
Radiology
Behavioral Health
Anesthesiology
Surgery
Rehab Billing
And Many More...
Medical Laboratories
At Credex Healthcare, we also deal in laboratory credentialing and payer enrolment which operates in a fairly different manner from regular insurance credentialing for healthcare facilities. Our team works alongside your laboratory’s management and ordering facilities to determine both the current and potential areas that provide the most beneficial business. To truly expand a laboratory business, it is essential to acquire multi-state payer enrollment and establish a thorough in-network contract directory to be able to serve the maximum number of customers.
Why Clients Trust Us
Years
12 Years of Provider / Hospital Credentialing and Enrollment experience
States
Extensive experience in all 50 states / State regulations / Rules and Compliance
WHAT OUR CLIENT SAY
Homecare Agency Owner
As a Homecare agency, navigating credentialing and enrollment can be a headache, but Credex Healthcare made it simple and straightforward. They took care of everything from our NPI management to PECOS enrollment, ensuring compliance at every step. Their expertise in primary source verification and network research helped us expand our network, allowing us to provide care to more patients. Highly recommend!
Pediatric Group
Credex Healthcare has been an invaluable partner for our multi-specialty group practice. They handled all our credentialing and enrollment needs, ensuring every provider was up-to-date across insurance networks and credentialing portals like CAQH and PECOS. Their ability to track and manage multiple providers’ licenses and certifications has saved us a tremendous amount of time and reduced our administrative burden.
Lab Director
Running a lab comes with its own set of compliance challenges, but Credex Healthcare has taken care of it all. They managed our CLIA waiver, credentialing, and enrollment processes, ensuring that we met every regulatory requirement. Their attention to detail and ability to handle complex credentialing issues has allowed us to focus on our operations without worrying about missing deadlines or facing compliance issues. Exceptional service!
HomeHealth agency Owner
Credex Healthcare has been a game-changer for our HomeHealth agency. They managed our credentialing process from start to finish, ensuring all our licenses, DEA registrations, and CAQH profiles were up to date. Their expiration tracking system is incredibly helpful in keeping everything in check. Thanks to them, we can focus on delivering quality care to our patients without worrying about administrative hurdles.
Nurse Practitioner (NP)
Credex Healthcare has been amazing to work with. As a Nurse Practitioner, they took care of everything, from managing my NPI and PECOS enrollment to handling all my licensing and revalidation requirements. Their support has allowed me to concentrate fully on patient care, and their thorough primary source verification ensured that my credentials were always accurate and up to date. I couldn’t ask for a better partner!
Dentist
I’ve had an outstanding experience with Credex Healthcare. They took over my credentialing, managed my CAQH profile, and handled my DEA registration with ease. Their team made sure my practice stayed compliant and helped me with network research and application follow-up. I don’t know what I would do without them handling all the administrative tasks!
Real-time updates and transparency
At Credex Healthcare, we excel in our services not just because of the skill level employed, but also because of the best practices and work ethic that we follow. At the core of our work is the principle of transparency. Our team provides complete transparency into the credentialing and enrollment process, checking in with consistent updates on the application status, and touching base with extensive reports, HIPAA compliant document storage, and general information about the pater network. By focusing all of our actions on the principle of transparency, we have reached newer, more efficient heights and a stress-free work process.
This way, not only is the right material delivered at the right time, but we go above and beyond to excel in our customers’ expectations.
