Blog

Home / Blog

HOW PHYSICIAN CREDENTIALING CAN BE A SMOOTH PROCESS

Share Button

A couple of decades ago healthcare physicians considered credentialing as the procedure for enrolment with an insurance company’s preferred provider network.  Now a days, it is mandatory than ever for physicians and healthcare providers including nurses, chiropractors, psychologists, counselors, LCSW’s and many others to be in network with insurance companies. This is a necessity because most people in the United States have health insurance than ever before.  And it is necessary because people today demand their healthcare physicians accept their insurance.  Honestly saying, if a physician is not in network with a patient’s health insurance plan, the provider is at risk of losing that potential patient to a competing practice.

Medical Credentialing referred to as insurance credentialing or provider enrollment is the process of becoming affiliated with an insurance company so that physicians can accept third party reimbursement. Enrollment applications can be +40 pages long, and to ensure smooth processing there’s a lot of necessary, time consuming, follow-up.

The process of getting on insurance panels can be challenging and lengthy.  It normally takes between 2-3 months to submit the necessary paperwork and correspond with insurance companies’ credentialing departments, before getting approved to join an insurance panel.  Because of the large amount of paperwork and correspondence required, medical providers generally find the process to be very time consuming.

Medicare, State Medicaid, Private/Commercial Payer Management involves

  • New Payer Contracts or Enrollments
  • Re-Credentialing or Revalidations
  • Changes of Information- Ownership or Acquired Locations
  • NPI Enumeration / Management
  • Set up of EDI, EFT, ERA, PECOS Processes or Provider Web Portals
  • Payer Issue Liaison / Resolution with Payers
  • Local, State, Federal Licensure Procurement

Why not choose a professional credentialing service provider like Bristol Healthcare Services to complete your provider enrollment process?

Bristol Healthcare Services is a medical billing and coding company serving physicians for over 20 years. We offer the entire gamut of billing and coding services. Physician credentialing and enrollment is a service we offer to make the whole credentialing process a smooth one for physicians. We ensure that all documentation needed for this process is complete. We eliminate the stress involved in this process.

Talk to us today. We are here to help you!