Provider Enrollment and Credentialing Services
Provider credentialing is the procedure of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. This process enables patients to utilize their insurance cards to pay for medical services consumed and allows the provider to get reimbursed for the medical services provided. Therefore, it is essential for healthcare providers to get registered with as many as possible insurance companies so that patients can use their insurance plans at your practice; failing to enrolled with insurance companies will result in the patient looking for competing providers who are registered with the insurance companies they have subscribed.
The process of credentialing with a payer involves a lot of work in terms of filling the application forms, giving clarifications to questions from payers, and following up with them to complete the credentialing request. Trust Hybrid IMS to get you credentialed fasters as we understand entirely the forms needed by each payer, and their procedures and policies.
Provider Credentialing Process
The process of Credentialing involves the following steps:
- Application Evaluation. Completing required documentation and identifying exceptions.
- Primary Source Documentation. Verify practitioner/ facility information from physicians.
- Outbound Call Center. Obtain missing documents and updating payer’s database.
- Follow-up with payers. Follow-up on submitted credentialing requests.
- Data Entry. Capture data, label, and link images to specific providers/ facilities in payer’s database.
- Maintenance of Provider Data. Update provider information as per policies and procedures and CAHQ profile.
Provider Enrollment
Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We continuously in touch with the insurance companies to guarantee applications are received and being processed on time. We work carefully to identify and resolve possible administrative problems before they crash providers reimbursements.
The process of Enrolment involves the following steps:
- Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims
- Updating practice’s Pay-to address. Validate and update the provider’s pay-to address or the billing address
- Enrolling for electronic transactions. Our team can register providers for four different types of electronic transactions:
- Electronic Data Interchange (EDI)
- Electronic Remittances Advice (ERA)
- Electronic Funds Transfer (EFT)
- CSI
- Monitoring of the process. Hybrid IMS have a team of highly skilled experts trained to perform research and analysis on the possible processor functionality gaps.
Our Motion for the Providers Credentialing and Enrollment Services
- Keep the data up-to-date with the payer
- Process quick payment from insurance and get more patient referral
- Reduced revenue leakages
- Avoid load of paperwork and filling of applications form
- Mitigate denials and identify providers trend
- Build working relationships with various payers.
- Provide timely status of credentialing and enrollment transactions.