Provider enrollment and Credentialing is your Key to Success

Provider enrollment and credentialing are the backbones of every healthcare practice. To sustain a constant supply of referrals as a provider, you must be enrolled with commercial and government insurance companies or funders. and accounts receivables.

Credentialing is the complex process by which a provider’s background, education, identity, residency, licensing, and other criteria are verified. Provider enrollment is the process of requesting enrollment with commercial payors, Medicare, and/or Medicaid.

Are you establishing a new practice? Are you affiliating with or joining a new group of practitioners? Do you want to enroll with new payors? Is a new physician joining your practice?

Well, these are instances of why you may need regular provider enrollment and credentialing services. It can prove beneficial to outsource such services to a medical billing company to ensure they are done in time and updated.

Salient Features of the Process

• Filling the necessary application forms and compiling required documents and certificates
• Submitting accurately filled forms and certificates to payors for faster approvals
• Taking care of all enrollment and credentialing formalities that are specific to each payor you want to enroll with
• Verification of records and certificates
• Maintaining every record necessary for the process
• Keeping track of registrations that are soon to expire such as NYS, MA, DEAs and CLIA.
• Handling and monitoring re-applications of the same
• Processing re-credentialing whenever necessary and updating in the system

Key Benefits of Efficient Enrollment & Credentialing for a Medical/Dental Practice

1. Faster credentialing will assist faster enrollment with payors resulting in steep reduction of AR delays.
2. Reduction in claim denials will give way to smooth cash flow and a financially healthy practice that is able to grow and profit.
3. Provider will gain more patient referrals from the network.
4. Improves turnaround time to within 60 days of submission of claims.
5. Compliance with insurance payors avoids legal hassles and yields a more efficient revenue management cycle.
6. Avoids wasting of staff time in follow ups for delayed AR.
7. Clients who’ve had care through payors in which you’re enrolled are instantly notified, which increases earnings.
8. Increases customer satisfaction and goodwill due to a hassle-free process. The practice earns great reviews both online and through word-of-mouth.

3 Mistakes to Avoid

Inaccuracy in filing out the information

When the process is already lengthy, every error can increase the timeline and delay much needed enrollment. Even simple mistakes in information such as practice address or failure to sign the forms can cause significant delays and major mistakes can be grounds for denial.

Delay in starting the process

It is advisable to start the credentialing and enrollment process at least 90 days prior to opening of a new practice. Even if you’re joining an existing practise, you must start the procedure well ahead of time. for ensuring accuracy and regular follow ups.

Lack of follow-up with payors

Credentialing process is not only lengthy but can take months to process for many practices. Ensure regular contact with the payors and stay up to date on application status to shorten the wait time.

Spectrum Healthcare Inc. – Provider Enrollment & Credentialing Services Company

As professionals who manage medical and dental revenue cycle management every day, we understand how time-consuming, complex, and annoying the processes for provider enrollment and credentialing are. Especially if you are working as a team of physicians, it is required to submit and monitor multiple applications and handle the overwhelming paperwork on time with accuracy.

At Spectrum Healthcare Inc., we have the expertise to handle each of these tasks for you so you may focus on more important areas of your practice.

Get in touch with us!