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Healthcare Insurance Credentialing Services

Credentialing can be tedious and tiresome!

Application after application.
So many documents to submit.
Never-ending calls to insurance companies.
Not to mention...DENIALS!

Don't do this alone. We can help you!

We will assist Healthcare Providers and Healthcare Business Owners
of all specialties, in all states.

Smart Phone Outline
Medical Checkup

Our services include:

  • Private insurance provider enrollment 

  • Medicaid enrollment 

  • Medicare enrollment 

  • HRSA enrollment for uninsured COVID-19 testing

  • Application tracking and follow up

  • Rejection and denial assistance 

  • Reapplication assistance if needed

  • NPPES, CAQH, Availity and PECOS registration, update & management upon request 

Cost of Services

$159

For credentialing applications per insurance company including private payers, Medicaid and Medicare

$179

One time fee for NPPES, CAQH, Availity, PECOS and other insurance clearinghouse registration, update & management upon request

$149

Per insurance company for re-credentialing, renewals and recertifications for current/previous clients

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Credentialing Applications

Credentialing process takes up to 90-120 days or more

 

  • If you are credentialed with a payer through another company or employer, some payers will allow you to update your profile by changing or adding new  EIN's – This process is shorter and known as a demographic update. However this is not a guarantee for credentialing or for a faster process.

  • New Applications - Some payers take up to 120 days or more depending on the process that they have in place

Credentialing Process 

  • Obtain all necessary documents and information that are required for credentialing 

  • Verification is done if provider has been credentialed before – This determines if a full or a demographic application is need. 

  • Applications are initiated within 72 hours after all required documentation and information is received

  • 3-4 weeks after submission we will call and verify that applications have been received, after this we contact the insurances and payers every 4 weeks until for confirmation and status updates

  • Inform provider of updates on credentialing application status routinely

  • Assist with denial/rejections

  • Reapplication assistance as necessary

  • Credentialing renewal and recertification upon request 

Required Credentialing Documents 

Not all documents will apply to every practitioner/provider/professional

 

Required Documents for each Provider/Practitioner/Professional : 

 

  • Professional License(s) 

  • Malpractice Insurance (Certificate of Insurance) 

  • DEA Certificate  

  • Board Certification(s) 

  • NPI Numbers

  • Social Security Number

  • Diploma - copy of highest level of education (M.D., D.O, MSN, BSN etc)

  • Certificates of completion for all medical training (internship, residency, fellowship, courses, trainings) 

  • Current copy of CV (showing current employer and your business/practice and MM/YYYY on all education and experience) 

  • Completed IRS Form W-9 with signature

  • Current Driver's License 

  • Login and passwords for NPPES, CAQH, PECOS, HRSA and/or Availity (if applicable)

 

Required Documents for each Business Entity:

 

  • Business Registration/License from State (City/County Registrations if Applicable) 

  • IRS form CP575 or replacement letter 147C (verification of EIN) 

  • US Business Bank Letter and/or Voided Check

  • Signed W-9 Form 

  • CLIA Waiver Certificate (if performing laboratory tests in your clinic)