Healthcare Insurance Credentialing Services

Your Partner in the Credentialing Process

□ Get enrolled with a Private insurance provider

□ Add new revenue streams with Medicaid, Medicare, and Private Insurance enrollment and re-enrollment

□ Register, update, and manage your NPPES, CAQH, Availity and PECOS upon request

□ Get assistance for rejection and denial

□ Track and follow up your applications

For commercial insurance credentialing applications, per provider excluding Medicaid and Medicare

For Medicaid or Medicare credentialing applications, per provider.

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

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

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 only after all required documentation and information is received
Approximately 4 weeks after submission, applications are verified received by insurance company.
Application status updates are obtained every 4 weeks from insurance companies
Assist with denial/rejections. (Additional cost may apply)
Reapplication assistance as necessary. (Additional cost may apply)
Credentialing renewal and recertification upon request. (Additional cost may apply)

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)

Credentialing Form