Credentialing Solutions
Medicare Credentialing
In order to service Medicare patients, a practice must be approved by Medicare through the credentialing process. Although CMS is Nationwide, the application must be submitted to the Medicare Administrative Contractor for the state in which the provider will be servicing patients.
Read MoreMedicaid Credentialing
Medicaid widely varies from state to state. So each Medicaid application will be specific to the State in which the practice will be servicing patients. Due to Medicaid being state funded, it requires a tremendous amount of detailed information to become credentialed.
Read MoreCommercial Credentialing
Commercial Insurance plans require credentialing and contracting in order for providers to service their patients, otherwise they will pay at an Out-of-Network rate. Although Commercial plans vary widely from state to state, there are a few that are common nationwide. Examples are Blue Cross and Blue Shield, Aetna, Cigna, and United Healthcare.
Read MoreRecredentialing
Once a provider is on an insurance panel, they will have to be recredentialed periodically. This process is to ensure that the providers credentials are up to date and in line with the policies of the insurance company. These renewals usually occur every 2-3 years. Failing to update credentials may cause an issue with your contract, or a provider can even be removed from an insurance panel.
Read MoreEFT Setup
EFT, or Electronic Funds Transfers is the process of having funds or payments from the insurance company directly transferred into your business account. This process ensures that providers receive their payments directly without having issues such as lost, stolen, or missing checks. This process requires setup by each individual insurance company.
Read MoreERA Setup
ERA, or Electronic Remittance Advice is the process of receiving remittance advices (explanation of benefits) electronically directly through your clearinghouse. This prevents posting delays due to missing or lost mail. This process is hassle free, and is a great feature to have in conjunction with EFT's. This process requires setup by each individual insurance company.
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