Provider Credentialing: A Vital Step for Healthcare Practice
Provider credentialing is a critical process that involves verifying the qualifications and credentials of a new healthcare provider before they are hired by a practice. While healthcare practices typically manage this process when onboarding a new provider, it is also a requirement by insurance payers as part of the provider enrollment process.
Gathering the necessary information for credentialing can be time-consuming and complex, often requiring extensive documentation and careful attention to detail. The credentialing process can take up to 120 days, and in some cases, it may take even longer, depending on the payer's requirements.
During this processing period, certain payers may allow "incident-to" billing. This means that while the credentialing process is underway, the new provider can begin seeing patients under the supervision of an already credentialed provider. The supervising provider, who is typically credentialed with the payer, can sign off on the new provider’s claims, ensuring that your practice can continue to operate smoothly while credentialing is in progress.
At Assured Credentialing LLC, we understand the complexities and time commitments involved in provider credentialing. We are here to streamline the process, ensuring that all necessary steps are completed efficiently and accurately, so you can focus on delivering care to your patients.
Provider Enrollment: Ensuring Seamless Integration
Provider enrollment is the process of officially enrolling a healthcare provider with insurance payers, enabling them to receive payment for the services they deliver. Similar to provider credentialing, this process can be complex, time-consuming, and often frustrating. Each insurance payer has its own specific requirements and procedures, making provider enrollment a highly detailed and intricate task.
The provider enrollment process typically involves completing and submitting numerous forms — sometimes dozens or even hundreds — to meet the varied demands of different payers. It’s essential to ensure that all information is accurate and up-to-date. Even the smallest mistake can lead to a rejected application, causing delays and forcing you to restart the entire enrollment process.
At Assured Credentialing LLC, we specialize in managing the provider enrollment process efficiently and accurately, ensuring that your practice is set up for success with insurance payers. Let us handle the paperwork, so you can focus on providing quality care to your patients.
Other services
Rate Negotiations
At Assured Credentialing LLC, we offer expert contract rate negotiation services to help you secure the most favorable rates with insurance payers. Each payer has its own set of guidelines for negotiations, but our team will work closely with both you and the payer to ensure that you receive the best possible rates for your services. Let us handle the complexities of rate negotiations so you can focus on growing your practice and providing exceptional care.
CAQH/NPPES Setup & Maintenance
All healthcare providers are required to establish and maintain a CAQH and NPPES account. At Assured Credentialing LLC, we assist you with the initial enrollment process and ensure that your accounts remain up-to-date. CAQH requires re-attestation every 120 days, and we are happy to handle this responsibility for you, ensuring a smooth and compliant process. Let us manage the details so you can focus on what matters most—your patients and practice.
PNM (Ohio Medicaid) Portal Training
For group practices wanting to manage their Medicaid enrollments independently, Assured Credentialing LLC offers training on the Ohio Medicaid PNM (Provider Network Management) portal. Our training helps you navigate the portal with ease, from initial enrollments to ongoing updates and revalidations.
We provide hands-on, personalized training to ensure your team can efficiently manage Medicaid processes, reduce errors, and save time. With our guidance, your practice can handle Medicaid enrollments accurately and confidently, giving you full control over your provider network management.