The process of medical credentialing is not just critical to developing a practice that strives to deliver top-notch patient care; it is also essential when it comes to insurance reimbursement. It is through the credentialing process, that insurance providers are able to determine which of the medical providers actually meet all requirements.
At Ehealthsource, our objective is to successfully credential as well as recredential our partners into various PPO / Managed Care organizations, including online enrollment through the CAQH (Council for Affordable Quality Healthcare). This process is about checking the Education and training, Qualifications, Licensing, Residency, Specialty certificates, and Career history of medical practitioners.
The Credentialing Department at EHS is well-equipped to manage the entirety of credentialing process for you. Here’s an overview of what the cedentialing process typically includes:
- Conducting a full audit of health plan that includes confirmation of remittance address and TIN linkage for every provider.
- Credentialing document retrieval which includes the tracking of expired documents.
- Finishing up the application for initial credentialing as well as recredentialing.
- ● Submitting application for the health plans.
- ● Following up with all the insurance carriers about the credentialing application.
- Storing all provider ID numbers into the EHS billing system to ensure accurate claims submission.
- Storing every provider ID number into the billing system of EHS in order to ensure there’s no discrepancy with the claims submission
- Developing and then maintaining the complete list of carriers as well as the provider ID numbers associated with them.
- Obtaining NPI (National Provider Identifier) numbers.
At Ehealthsource, our Credentialing Department consists of brilliant Credentialing Coordinators and Analysts with years of wide credentialing experience that includes hospitals, PPOs, HMOs, IPAs, and managed care companies. And it’s a staff dedicated to use its diverse knowledge and experience to provide excellent full-time credentialing service to all our clients.