CREDENTIALING VERIFICATION

The credentialing process involves verifying a provider’s background and qualifications for providing health services. Payers require verification of a provider’s education, experience, training, certification, and more. This process is complex, time-consuming, and exhausting. Taking this all on yourself costs time and attention away from your practice operations and your patients. That's where CredentialingOne comes in . . .

New Practice Credentialing

Let our experts remove the headache of filling out provider credentialing paperwork by cutting through all the red tape for you. Our automation technology autopopulates credentialing forms and our experienced staff ensures your submitted application gets processedSimply review the documentation and sign (if required) for submission.  

Existing Practice Credentialing

A practice, group, or facility must have all providers’ and locations’ NPIs credentialed and contracted with payers. It is not unusual for a practice without a credentialing program to fail to add any new locations or plans to their existing agreements. These types of omissions will result in denied claims and lost revenue. 

We will prevent these issues by obtaining a Type 2 NPI for your locations and completing all required applications and demographic changes for your payers. Our team will follow the credentialing and contracting through until the new location and providers are loaded in the payer system for claims processing. 

You are informed every step of the way with our alerts and reports.

We can manage your future credentialing and contracting work as well; you no longer need to hire and train additional employee(s) for these tasks. CredentialingOne is also a great option for temporary credentialing staffing.

Health Plan Audit

Insurance plans change and provider turnover is part of the business. CredentialingOne provides auditing services to ensure providers are participating in the correct plans and your provider roster is current. 

An annual audit of plan participation is critical for front desk collections. It’s important to understand the plans your practice and providers participate in when collecting the appropriate co-pay or deductible. 

There are many potential changes to monitor, including: 

  • Payer contracts may require practices to notify them within 30 days of a provider’s termination (resignation, retirement, etc.), but many practices forget to do so. 
  • As new plans are added by a payer, credentialed providers may not realize they need to opt-in to participate. 
  • Payer contracts may require providers to opt-out of plans or they will automatically be included in them. 

We can keep track of all these moving parts for you. Make CredentialingOne your health plan audit service! 

PREVENT THESE CREDENTIALING MISTAKES

CredentialingOne can help you avoid these and other errors that lead to denials and underpayments:

INCORRECT PHYSICIAN DATA

An incorrect entry in the insurance plan's billing system

SUBMITTING A CLAIM INCORRECTLY

Incorrect practice or facility data when submitting a claim

EXPIRED CERTIFICATES

Expired licenses, certificates, or insurance

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