Importance of Provider Credentialing Services

Getting a provider credentialed with a payer is about too many manual tasks like completing application forms, offering clarifications to questions from payers, and taking regular follow-ups to close the credentialing request. With 24/7 Medical Billing Services, you can easily keep your data updated with payers by using our Provider Credentialing Services.

Provider credentialing is in short a process of getting a physician or a provider associated with payers, which is an important step in the revenue cycle of any healthcare practice. The process lets patients use their insurance cards to pay for particular medical services availed and allows the provider to get reimbursed for the medical services provided. Thus, healthcare practices need to get enrolled and credentialed with most payers so that patients can utilize their insurance plans correctly. When failing to do so, it will result in the patient struggling for competing providers who are registered with the health insurance companies they are subscribed to.

But, the process of credentialing a provider with a payer is about a lot of manual work of completing the application forms, providing descriptions to questions from payers, and following up with them to close the credentialing request. You can trust 24/7 Medical Billing Services to get you credentialed quickly as we understand the forms required by each payer, and their policies and procedures.

Provider Credentialing Process Involves:

Application Evaluation: Completing needed documentation and knowing exceptions.

Primary Source Documentation: Confirm practitioner/ facility information from practitioners.

Outbound Call Center: Get missing documents and update the payer’s database.

Follow-Up With Payers: Taking regular follow-ups on submitted credentialing requests.

Data Entry: Get data, label, and link images to particular providers/ facilities in the payer’s database.

Maintaining Provider Data: Update provider information according to policies and procedures, and CAHQ profile.

But why Provider Credentialing Services are important for your practice?

It Prevents Healthcare Organizations from Revenue Loss

The main reason why properly credentialing providers ensures compliance to state and federal regulations. The reason why a healthcare organization seeks payment from a professional insurance carrier, or a government program like Medicare or Medicaid on the offered services by an excluded nurse, physician, aid, pharmacist, or other providers, the payer can refuse reimbursement. Wherein, if the reimbursement has already occurred, the clinic or practice can be fined, hit with civil monetary fines, and may be ordered to repay the amount of reimbursement in full and sometimes in multiple penalties.

Medical Credentialing Protects Your Patients

A credentialed provider should be continuously checked against when LEIE is the only data point. Other necessary primary source publishers to verify are FACIS®, OFAC, National Abuse Registry, Sex Offender Registries, and Social Security Death Master File, at a minimum.

Credentialing Saves Practices from Lawsuits

While provider credentialing is an important yet precautionary process that covers the bases of compliance and best practices, there are still some cases where things may get out of the control of providers and administrators.

Provider credentialing and enrolment services allow you to:

  • Keep your data updated with payers
  • Process faster payments from insurance and get more patient referrals
  • Minimize revenue leakage
  • Prevent paperwork and filling out application forms
  • Reduce denials and identify provider trends
  • Build relationships with different payers
  • Obtain real-time status of credentialing and enrollment transactions

Get in touch with the 24/7 Medical Billing Services team to know more about our offerings in Provider Credentialing and Enrollment Services.

Read more: Top Medical Billing Companies In The US

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