Fast & Accurate Credentialing: Services for Insurance Payers

Credentialing Services Medical OfficeOne of the services that we provide to our clients, as healthcare consulting companies solutions, is fast and accurate credentialing and recredentialing services. The simple definition of credentialing, is that it is a process that is used to get and review necessary documentation of a physician, practice or clinic for the purpose of determining participation privilege status within a specific health plan.

When you are credentialed with an insurance panel, that means you are able to take new patients and see existing patients who are insured under specific plans. After those patients are seen, you can bill their insurance companies for the services that you provide. Being credentialed with popular insurance panels allows you to increase the number of patients that you can serve.

What Happens if You are Not Credentialed
Physicians, clinics and practices that have not received the proper credentialing and recredentialing services, as they are needed, are unable to see patients who fall under specific insurance plans that require preferred providers or pre-approved and credentialed physicians in order to process payments. Fast and accurate credentialing is required whenever you bring on a new physician to your practice or clinic, so that they can see patients who already visit your office that fall under the insurance panel plan.

While clinical coding optimization is essential to making sure that you keep the cash flow moving at your ENT practice or clinic, it won’t do you any good if your physicians aren’t properly credentialed with the most popular insurance panels and programs. Some of those insurance companies include Aetna, Blue Cross, Blue Shield, Cigna, Health Net, Highmark, Humana, Kaiser, Medicare, Regence Group, United Healthcare, Wellpoint and Wellcare, just to name a few. If one of your physicians is not credentialed with these popular providers, you could be losing money on a daily basis by not being able to service these patients.

What is Required for Credentialing?
When you work with healthcare consulting companies like MD Pro Solutions to provide you with fast and accurate credentialing and recredentialing services, you will need to provide some specific documentation. Some of the required documentation can include the details on the training and education of the applicant, clinical privileges, accreditation, certifications, experience, licensing and much more. In addition, liability insurance, the applicant’s malpractice history and professional competence will also be considered.

In most cases the terms credentialing and recredentialing include both the collection of the documentation mentioned above, as well as the verification of it. The information must be validated as being accurate and complete. There are several steps required for the credentialing process, which is why many busy practices and clinics prefer to hire healthcare consulting companies like MD Pro Solutions, who have many years of experience working with credentialing and recredentialing services, to take care of it for them.

What to Expect from the Process
Once you submit all of your documentation to the team here at MD Pro Solutions, the entire process takes somewhere between 90 to 120 days. If you have a new physician that is coming to your practice, it is in your best interest to get the documentation from them in advance so the process can begin before they arrive.

When you use a company like MD Pro Solutions to take care of your fast and accurate credentialing and recredentialing services for you, we start the process immediately to help push the paperwork through as quickly as possible. We follow-up with the insurance companies to make sure that everything gets processed and approved on their end as quickly as possible.

Other Services from MD Pro Solutions
In addition to credentialing, healthcare consulting companies like MD Pro Solutions who specialize in otolaryngology clinics and practices, also offer other services. Training and certification, as well as support for clinical coding optimization to help improve your billing and coding department. We also have outsourced billing services that you can use while your staff goes through training and your current system is audited and checked.

Take advantage of all the options available for ENT practices and clinics at MD Pro Solutions to help make improvements that really make a difference in the value and effectiveness of your medical practice. Give us a call at 508-946-1665 to get a FREE consultation or to learn more about our fast and accurate credentialing services.