Provider Credentialing

Provider Credentialing and Enrollment Services

Accounts Receivable (AR) is the money owed to Providers or medical billing companies for the medical care rendered to patients.
The generated invoices are sent out to insurance companies or patients for payment

What is Accounts Receivable Management

Physicians/providers must credential themselves, i.e., enroll and attest with the Payers network and authorized to provide services to patients who are members of the Payer plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physicians education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.
Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively. Our customized Payer credentialing and enrollment services support physicians in

  • Starting or joining a new practice
  • Switching from one physician practice group to another
  • Enroll with new payers

OUR CREDENTIALING PROCESS INVOLVES THE FOLLOWING

  • Collect all the data and documents required for filing credentialing applications from the physicians
  • Store the documents centrally on our secure document management systems
  • Understand the top payers to which the practice sends claim and initiate contact with the payers
  • Apply the payer-specific formats after a due audit
  • Timely follow-up with the Payer to track application status
  • Obtain the enrollment number from the Payer and communicate the state of the application to the physician
  • Periodic updates of the document library for credentialing purposes