Provider Enrollment & Credentialing

PROVIDER CREDENTIALING

The process 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.
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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 constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process 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 enroll providers for four types of electronic transactions:
  • Electronic Data Interchange (EDI)
  • Electronic Remittance Advice (ERA)
  • Electronic Fund Transfer (EFT) and
  • CSI
• Monitoring process.A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.