Providers Enrollement & Credentialing Services

Physician or provider credentialing, the process by which they become affiliated with payers.  It is an important component of the revenue cycle. The process allows patients to use their insurance cards to pay for medical services. The providers get reimbursed for the medical services they provide. Thus, healthcare providers must enroll and obtain credentialing with maximum payers in order for patients to use their insurance plans. Whenever this happens, the patient looks for competing providers who are enrolled with their health insurer. Credentialing services for providers in the USA can prove to be a strenuous and lengthy process.

A great deal of manual work is required to obtain payer credentialing for a provider. This includes filling out applications, answering payer questions, and following up.

We, at Virtual Healthcare, know all the documentation and requirements each payer needs, as well as the policies and procedures that go along with it, so we can get you credentialed faster. You will have no stress related to the enrollment services in medical once you choose us as your company to carry out the credentialing on your behalf.

Why is there a need for credentialing?

 Credentialing may seem like an obstacle to you as a healthcare provider that will prevent you from earning and result in lowering your earnings. Credentialing, however, has the purpose of ensuring only trustworthy practitioners are providing care. A doctor’s ability to provide care can either decline or improve over time. Also, there are always factors such as behaviour, dedication, age, or any unprofessional behavior that make a practitioner unsuitable for providing care. After all, delivering clinical procedures is a matter of privilege and responsibility as well, and also the provider or practice needs to be accredited with the Insurance for certain services.

Credentialing involves checking the credentials and documents of application practitioners. These include certifications, affiliations, physician licenses, clinical judgment, accreditation, and many more.  By reviewing aspects like a physician’s license, experience, certification, education, training, affiliations, malpractice & adverse clinical events, and clinical judgment, credentialing verifies if the physician meets the Payer’s standards.

Credentialing of providers:

The steps involved in the process of provider credentialing are as follows :

    Evaluation of the application. Identification of exceptions and completion of required documentation.
    Documentation from the primary sources. Check information from physicians about practitioners/ facilities.
    The outbound call center. Retrieve missing documents and update payer records.
    Thorough Follow-up with payers. Resolve credentialing issues.
    Data Entry. Identify providers and facilities in the payer’s database by collecting data, labeling, and linking images.
    Provider data maintenance. Correct provider information in accordance with company policies and procedures.