PROVIDER ENROLLMENT

Provider enrollment allows you to submit electronic data interchange (EDI) transactions to payers and get reimbursed for your services. Our provider enrollment services speed up the contracting process with both commercial and government payers, including Medicare and Medicaid. The sooner you are added to these health plans, the sooner you can get paid.

We verify that payers have the data they need to process claims for the services you provide to your patients. Our experienced enrollment team monitors every step of the enrollment process to ensure you are accepted as quickly as possible.

The Provider Enrollment Process May Include:

  • Requesting enrollment/contracting with a payer 
  • Completing the payer’s application 
  • Submitting documentation (e.g. licenses, certificates, malpractice insurance) 
  • Reviewing and signing a contract 
  • CAQH credentialing 
  • Verifying provider information (confirming payers have accurate provider information on file before submitting a claim) 
  • Validating practice pay-to address (confirming payers have the correct provider billing address) 
  • Enrolling for electronic transactionsElectronic Data Interchange (EDI), Electronic Remittance Advice (ERA), Electronic Funds Transfer (EFT), CSI 
  • Additional steps unique to particular payers 
Credentialing Compliance
Why CredentialingOne?
  • Experienced Credentialing Specialist assigned to your account 
  • Timely and accurate enrollment and credentialing applications 
  • Weekly status report indicating progress, deficiencies, and approvals 
  • Submit, monitor, report enrollment progress through effective date  
  • Cloud-based, HIPAAcompliant provider data bank 
  • NPI – Type 1 and Type 2 obtain or update as required 
  • CAQH – Enrollment, updating and attestation 

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