Medical Credentialing

Simple provider credentialing in just a few short steps. 

Medical Credentialing
FAQs

The process should start with a review of specific network needs, or an evaluation of the top payers in the area. Once final decisions are made, a contract is executed for the work to be done and payment is made.

The credentialing team gathers all necessary documents from the provider and contacts the insurance companies to begin the application process. The process can typically be completed online through a company’s portal for form completion. If not, they will be filled out and sent via the required method.

After submitting the applications, timely follow-up with the payers is crucial to ensure they were received. We give bi-weekly status updates to keep the client informed throughout the process until an effective date of enrollment is determined and a contract is received and executed, so the provider can begin claim submission.

 

Outsourced credentialing companies should respond to requests in a timely manner and make it a priority to be provide excellent communication and total transparency. A provider should work with a company that’s professional, caring, and capable, taking ownership in the process as your representative when dealing with the insurance companies.

We aim to be accessible to our providers, so we assign them a credentialing representative to communicate easily when needed. We offer to analyze their payers for their specialty and geographical location, as well as evaluate their contracts. 

 

The physician credentialing process generally takes between 90-120 days. We begin by sending a checklist of all documents that are required. Once those are received, we upload data into our system and work to get applications completed and submitted to insurance companies. We then follow up regularly with the insurance companies to make sure the credentialing applications are received and being processed and approved without delay.

Yes. We have credentialed many specialities and practices sizes all over the US, including Hawaii!

Our re-credentialing and maintenance package tracks expiration dates and renewals of contracts for your networks. This includes BCBS, Aetna, and Cigna, as well as the various plans you’re enrolled with under their umbrella, including Medicare and Medicaid re-validations. We also provide CAQH maintenance and attestation every 3 months, notifying the provider of expiring documents, such as Malpractice, License, and DEA.

Provider Credentialing Process

Credentialing is the process of verifying a provider’s qualifications to ensure they can provide care to patients. Most health insurance companies require this process, including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.

The process is completed by verifying all of a provider’s documents to verify that they’re valid and current. These include their medical license, malpractice insurance, and DEA.

Our credentialing team can assist you in becoming an in-network provider with insurance carriers you want to participate with. We can even give you recommendations by performing analysis for your specialty and service area if you need a little guidance.

We also provide these services to existing practices. Credentialing physicians is an ongoing process and must be redone every 3-5 years. Ultimate Billing can complete re-credentialing, notify you of expiring documents, and help maintain your CAQH profile.

When you’ve gathered your documentation and are ready to get started, contact us.

Our team works with practices both large and small, and has extensive knowledge and expertise across multiple specialties and services, including DME.

With our medical credentialing services, we can assist you with provider enrollment and becoming an in-network provider so you can receive reimbursements from each carrier.

Since medical credentialing is more necessary than ever for providers to be in-network with insurance companies, don’t wait to get started. Contact us today. 

Information Needed to Complete Medical Credentialing:

Medical School Information

Internship/Residency/ Fellowships Information

Board Certifications

Provider’s CV

Medical Provider Credentialing Process

The medical provider credentialing process requires involvement from the healthcare provider, organization, and payer.

The organization provides the healthcare professional with the credentialing application(s). They are then responsible for completing the application and attaching all requested documentation, like board certification, college degrees, and more. When the application is complete, the provider submits it to the organization he or she plans to provide services under.

The organization is also responsible for attaching additional documentation: claims history, background screen results, primary source verification, and more.

Once they’ve completed any healthcare facility portions of the application and attached appropriate documentation, they submit the completed application and supporting documentation to the payer.

The payer reviews the application to determine whether the healthcare provider meets the payer’s standards. They will take the following into consideration: the provider’s education (and accreditation of that program), residency or fellowship, recommendations, malpractice claims history, license, and more.

This entire process is required when the provider first joins a new practice and then periodically thereafter, usually every 2-3 years, depending on the payer.

Required information often includes:

Outsourcing Credentialing and Re-Credentialing

Outsourcing Credentialing and Re-Credentialing

When you handle credentialing physicians in-house, you must:

  • assign resources to compile and send out application materials to new providers
  • track the completion and collect the documents
  • complete the facility portion of the application and credentialing process (like primary source verification, malpractice claims review, etc.)
  • send the applications to payers
  • respond to any requests for corrections or additional information from payers
  • track re-credentialing deadlines and initiate, track, and complete the process every time a provider is due for re-credentialing.

 

Most importantly, they must develop and maintain expertise in the provider credentialing process, including staying informed of changes in the industry, credentialing trends, and payer requirements.

Lack of expertise among the credentialing team can lead to denied applications or requests for more information from payers, which can cause a delay of services for patients who need them. For this reason, many healthcare organizations choose to outsource credentialing services for physicians to an expert third-party vendor, like Ultimate Billing. 

As experts in medical provider credentialing, we take on the credentialing process from start to finish. That means that all of the responsibilities that would typically fall on your facility can be completed by our medical credentialing experts, freeing up your team for more important work.

We will work with the provider to get the initial application completed, complete all tasks required of the organization, and coordinate with payers to support timely approval and speed up provider starts.

Benefits of Physician Credentialing Services

Ultimate Billing Credentialing Services for Physicians offers:

  • Credentialing specializing in all 50 states
  • Team of experts to navigate the paperwork
  • Cost savings so that you and your team can do what they do best–take care of your patients!
  • Updates on credentialing status within 24 hours
  • Save time and let us do the paperwork for you
  • Assistance with appeals for panel closures
  • Major medical provider enrollment; Medicare and
  • Medicaid enrollments for group and individuals
  • Payments from third-party payers arrive much quicker

Medical Credentialing Services

See what we have to offer below. Pricing readily available through our representatives. 

 

Medical Credentialing Services Options and Details
  • Completion of all required application(s)
  • Facilitation of entire process from start to finish
  • Follow up on process with insurance company
  • Updating information from address, phone number, fax number, etc.
  • Tax ID and NPI updates
  • Facilitation of entire process
  • Adding new location information
  • Completion of all paperwork
  • Follow up on process from start to finish
  • Completion of all enrollment forms (including EFT and contract paperwork)
  • Facilitation of entire process from start to finish
  • Tracking of the following documents expiration dates
  • Medical License
  • DEA/CDS
  • Board Certs
  • CEUs
  • Anything with an expiration date (i.e. CPR certs, etc.)
  • Notification of re-credentialing dates
  • Updating of CAQH
  • Updating of NPI (group and individual)

**Prices do not include fees charged by the insurance company. Those fees may be paid to the network directly.**

Why Choose a Credentialing Service?

Why Choose a Medical Credentialing Service?

Clients often share that they can’t afford to outsource credentialing physicians, but after a review of the expense of managing the medical provider credentialing process in-house, find that outsourcing offers big savings for the organization.

When you outsource your medical provider credentialing to a team of experts, efforts can be consolidated. This is because we can credential dozens of providers at once, every day, which allows us to save time and money in the process.