Providers Enrollement & Credentialing Services

Before a practice or a doctor starts getting payment through insurance companies, they must get themselves enrolled with them to get credentialed. The payer insurance company reviews the applications of the applicant doctor and compares them to internal standards. Provider enrollment and credentialing service is the process of obtaining enrollment from insurance companies by medical practitioners to get paid .

One of the reasons for getting the credentialing is a very important part of the revenue cycle is to become an ‘In Network’ provider. It means that as a practitioner who has signed the contract, can accept the insurance terms and conditions of the patient’s plan to provide services. In-network practice costs a lot less to patients, and if you happen to be an out-of-network practice, the patient is likely to be responsible for the extra payment that is not covered under their insurance plan.  That will surely make them stay away from you. Moreover, to improve the performance of any healthcare practice, effective provider credentialing is a paramount requirement.

Credentialing generally takes 2 to 3 months, but the process can become lengthier due to documentation issues, poor follow up, and poor filing. The lengthier the process, the more harmful it becomes for the revenue cycle. Even if the physician can provide efficient, competent and medically necessary services, payments may get delayed or refused by insurance companies without proper enrollment with payers.

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.

What Makes VO Health Care An Excellent Choice :

Vo Healthcare Specialty Credentialing offers comprehensive credentialing services. Our services include :
    Registration with the NPI (Type I and II)
    Protocols for reimbursement
    PECOS registration 
    Registration with CAQH
    Hospital Privileging Services 
    Revalidation of Medicare and Medicaid
    Credentialing and Enrollment  for Commercial Insurance Provider (i.e. Anthem, CIGNA, TriCare, BCBS, Humana, & UnitedHealthcare, etc.)
    Registration with the NPI (Type I and II)
    Handling of Care Contracting matters

Vo Healthcare is an ideal partner for provider enrollment & credentialing as we have all the qualities and all the features to make your enrollment process smooth. VO Healthcare dedicated specialists will manage every step of the credentialing process so that you can get the job done fast. New providers can start seeing patients sooner when the time for onboarding and privileges is shortened via our result-oriented credentialing services. Get in touch with us to experience easy, quick, and smooth credentialing.