Medical Billing and Credentialing Services for Providers

Healthcare Provider Verification Services

In the healthcare sector, the maintenance of current provider credentials is crucial but can be a source of frustration for medical establishments. A considerable amount of time can be lost in the maze of various insurer protocols.

By choosing our services, healthcare facilities have access to a streamlined path for all medical credentialing necessities. Our expertise ensures a comprehensive, hassle-free verification experience, adjusted to the individual needs of practices, hospitals, or independent medical professionals. We handle each step with precision, leaving you free to concentrate on patient care.

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Healthcare Credentialing Components

Healthcare credentialing encompasses a spectrum of procedures to certify the legitimacy of health care providers. Below, we outline the essential elements:

  • Assessing eligibility for various health insurers, including HMOs and PPOs, is crucial for effective credentialing. This process involves retrieving and completing necessary application forms, ensuring accurate execution of online forms, particularly for CAQH applications, and obtaining a National Provider Identifier (NPI). It’s essential to persistently monitor and update application progress, providing additional details as needed. Timely submission of re-credentialing documents upon request from health plans is also vital. Evaluating predominant insurers within a specific region can help target application efforts efficiently, whether for solo practitioners or group entities. Additionally, regular updates and maintenance of the CAQH profile are necessary to avoid any lapses in credentials.
  • Enrollment and configuration for payment systems like Payspan, EFT, and Optumpay must be managed alongside amendments to contact details, practice locations, and provider lists. Medicare re-validations need to be handled meticulously to maintain compliance. Furthermore, procuring and maintaining Hospital Admitting Privileges, along with the application and renewal of DEA Licenses, are critical tasks. State Licenses must be kept current to ensure uninterrupted practice operations. Finally, the creation and upkeep of National Provider Identifiers (NPIs) must be diligently managed to meet all regulatory and practice requirements.

Dependable Verification Services for Healthcare Professionals

Starting the credentialing journey, even though expansive, is a straightforward task with us. The duration of enrollment with insurance carriers varies but it ensures that patients receive safe and high-quality care. It also safeguards your practice by validating all necessary professional qualifications and legal requirements.
If you’re prepared to begin, our experts are just a call away at 866-331-3345. Our FAQs can also address any further questions you have. Let us simplify your credentialing to conserve your resources and time — get in touch with our team immediately.

Accuracy Assured

Our processes for both initial and ongoing verification makes certain that all provider details are current and precise, safeguarding against outdated information.

Insurance Affiliation

Affirmation of affiliation with various insurance entities to confirm eligibility for third-party remuneration for patient treatments.


Just submit the initial paperwork to us, and let our team handle the detailed, time-intensive procedures.

Comprehensive Checks

We thoroughly verify all facets including educational background, professional history, licenses, medical training, and insurances.

Experienced Team

Our specialists, wielding over three decades of experience, use the latest technology to efficiently manage your verification needs.

Support System

Our team is ready to assist you in gathering your documents and initiating the credentialing process.

Insurance Credentialing for Practices

Our clinics’ ability to bill as in-network providers hinges on completing the provider insurance credentialing process. This critical undertaking enables us to join insurance panels, paving the way for direct billing opportunities. By satisfying the established criteria and securing approval, we ensure our financial operations run smoothly, maintaining our capacity to be compensated for our services.

Physician Recertification Process

Periodically, we ensure our medical personnel maintain valid credentials. It’s a rigorous method that re-affirms their qualification, and it’s essential due to its role in detecting deceit and upholding healthcare standards. Every two years, typically, is when this re-evaluation is mandated. Should we overlook this, we risk facing penalties and retractions. Read this to know more about recertification standards

Steps in the Healthcare Credentialing Procedure

Common Inquiries Regarding Medical Billing and Credentialing

Healthcare credentialing is a systematic approach to verify and assess the qualifications of healthcare providers. This process typically covers these key activities:

  • Gathering necessary documentation: This can include evidence of professional licenses, educational transcripts, board certifications, and details of continuing education.
  • Primary source verification: Each credential is validated from the issuing source.
  • Committee review: A committee examines the collected credentials to make a decision on whether to approve the provider for the healthcare entity or insurance network.


Benefits of our Medical Billing and Credentialing Services