Medicaid Credentialing Services

What is Credentialing?

 

Credentialing is referred to enrollment of a healthcare practitioner in-network with the insurance carriers in order to treat insured patients and receive reimbursement. The credentialing process involves authenticating qualification of a healthcare practitioner and ensuring a practitioner’s credibility to deliver patient care. This process is standard across all insurance carriers such as Medicaid, Medicare and Commercial Insurances and requires re-validation or re-credentialing every two to three years. 

 

A provider has to submit several documents to initiate a credentialing request with the insurance carriers such as a Medical License, Malpractice Insurance, CV & Certificate of the D.E.A. Following is a list of all the documents necessary for credentialing: 

 

List of Documents Required for Credentialing: 

 

  • DEA Copy 
  • Updated CV (in MM/YYYY Format) 
  • Liability Insurance Certificate Copy 
  • Medical/Dental License 
  • Passport Copy ( If not a US citizen ) 
  • Visa Copy ( If not a US citizen ) 
  • SSN Copy 
  • Driving License Copy 
  • Diploma Certificate 
  • Specialty Certificate (If the provider is a Specialist) 
  • Anesthesia/Nitrous Certificate
  • Copy of Void check (if you want to opt for EFT)

How Does Credentialing Process Work?

 

There are mainly two steps in the credentialing process. Initially, when a participation request is submitted, insurance carriers verify the documents and provide a credentialing application to the approval committee. Once the credentialing committee approves the application, the last step is to complete the contracting. Upon completion of the credentialing & contracting process, you will be considered as an in-network provider and also receive the effective date. 

 

It is important to note that in-network reimbursements are only approved once the provider is fully contracted and listed in the claims system of the insurance carrier. Unlike Medicare insurance, commercial carriers do not allow retroactive billing and any claims before the effective date are considered for out of network billing only. 

 

What is the expected duration for Credentialing?

 

Credentialing is a time-consuming process and therefore, healthcare providers find it extremely challenging due to their busy schedules. While the standard turnaround time to complete credentialing is between 90 – 120 days. However, it can always vary depending on the insurance carrier. There are several instances where a provider might get credentialed  as quick as within 30 days or anywhere between 90 – 120 days. 

 

If you are a Durable Medical Equipment (DME) supplier and apply for credentialing with Medicare, it is advisable to expect a turnaround time anywhere between 90 – 120 days as the verification process of DME suppliers involves a site visit as well. The site visit is conducted by a verification officer of Medicaid. 

 

How Does 1Point Credsolutions help in Credentialing? 

 

The credentialing specialists at 1Point Credsolutions carry an extensive knowledge and experience of the credentialing process. Our credentialing specialists fully manage the process allowing you to focus entirely on patient care. 

 

A team of credentialing specialists is assigned to manage the application submission, document validation and communication with the insurance carriers. Your credentialing team ensures to keep you updated on the credentialing status as well as alert you when re-credentialing is due. With all the benefits involved, you also get a dedicated point of contact available 24/5 to help you resolve any queries. 

 

How much does credentialing cost? 

 

The overall cost for credentialing always varies for every provider depending on the insurance types they prefer to enroll. While credentialing with commercial plans like PPO (Preferred Provider Organization) can cost comparatively less than Medicaid or Medicare. 

 

In order to evaluate the right cost of credentialing services you can always contact a credentialing specialist at 1Point Credsolutions. Our specialists can help you find the right insurance carriers to enroll as well as the expected cost. 

 

What type of credentialing services do 1Point Credsolutions provide? 

 

1Point Credsolutions specializes in Medical and Dental Credentialing. Our credentialing services have proven to be a great resource for all types of general practitioners as well as speciality providers. The credentialing process for every provider is similar with slight variations. To know more about our credentialing services, you can always email us your enquiry at consultant@1pointcredsolutions.com or call (818) 722-1469. 

Our Key Services

  • Provider Enrollment

    We set up the Individual & Group Enrollment for Medicare, Medicaid, PPO, HMO among other plans for both Dental and Medical.

  • Fee Schedule Retrieval and Negotiation

    Our Experts will track Expiration Dates and Terms and will not let yet another contract get Auto-renewed annually. With our method and relations with DSO We can help you get the best contracted rates with insurance companies.

  • EFT Enrollment

    Get rid of the hassle of receiving and en-cashing checks with our EFT enrollment service. Authorizing EFT as your payment method will speed payment delivery by depositing payments directly to your bank account allowing quicker access to funds paid to you.

  • CAQH Registration & Enrollment

    CAQH Registration is important for submission of claims with many insurance. In case your enrollment will be delayed, and your claims will be denied. But you don’t have to worry no more! As we at 1 Point Cred solutions are here to help you with it.

  • Re-Credentialing

    Timely completion of re-credentialing is critical to be maintained as an In-network provider. We are here to manage that for you.

  • Additional Services

    NPI Enrollment, Demographic updates, Annual subscription, Web-portal enrollment and updation among any other customized service request.