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Medical credentialing and provider enrollment.

The process of obtaining approval for a medical professional to accept patients from a specific insurer and be paid by the insurer for services provided is called medical credentialing (or sometimes medical paneling or provider enrollment).  All healthcare providers know credentialing is necessary.  Not all realize the impact on revenue if credentialing isn’t handled correctly and efficiently.

If a physician starts seeing patients from a particular insurance company at the beginning of the month, but hasn’t been enrolled with that insurance provider, un-billable charges can easily be thousands of dollars.

The medical credentialing process is complex and time-consuming.  There’s limited to no commonality in the procedures or paperwork from insurer to insurer.  For a practice or individual provider, the work to get credentialed can be daunting.

Medical credentialing stats from the Medical Group Management Association.

Potential Days to be Credentialed (Industry Average)
Potential Payer Enrollment Application Page Count
Average Insurer Groups Per Medical Professional
Medical Professional Hours Spent Annually Managing Credentialing Requirements

Numbers like these are why many healthcare professionals and practices outsource medical credentialing to experts like Celeriti.  We understand the process for each insurer, have relationships with the insurance panel enrollment team that can be leveraged on your behalf, and follow a disciplined process that can cut up to 50% off the typical time to be credentialed, depending on the provider.

The bottom line is, “what is your time worth?”  Do you want to spend it negotiating the credentialing process?  If the answer is “no,” then let us handle it for you.  Our client typically find that Celeriti medical credentialing services pay for themselves in just a couple of appointments.

If you turn away just one new patient because you’re not credentialed with that patient’s insurer, it will directly impact your revenue.

Comprehensive medical credentialing solutions.

From behavioral health to urology, from individually employed providers to large group practices, our experience and strong relationships working with enrollment departments for dozens of payers across the country means that you can count on a fast, accurate resolution to any credentialing challenge. 

Here’s how we can help. 

Initial Credentialing | Re-credentialing

  • Secure document collection and rapid data entry
  • Comprehensive par/non-par assessment
  • Required content review
  • Electronic document management
  • Certified document tracking
  • Strong relationships with payer groups to insure applications are being actively processed
  • Compilation of Provider Identification Numbers (PINs) for billing
  • Automated reporting to track the credentialing process in detail

Expiration Management and Monitoring

  • Proactively track expiring documentation
  • Conduct necessary CAQH re-attestations
  • Address enrollment and credentialing related billing challenges

Project Work

  • Credentialing audits and corrective action
  • Medicare re-validation
  • Group contracts
  • TIN consolidation and enrollment
  • Delegated credentialing rosters for delegated payers
  • Payer website audits (to insure provider data is accurate)

Frequently asked questions.

How does the credentialing process work?

  1. Our team helps you identify and collect needed documentation.
  2. We work together to determine the insurance panels for which you’ll be credentialed.  We can work with you on your patient base to identify current critical insurers, and also identify insurers to add to maximize your patient accessibly and revenue.
  3. Then we focus on enrollment.  We have disciplined processes we follow that are unique to each insurer to insure that we get you credentialed in the shortest possible time.
  4. There is regular follow up with the insurance panel administrators to insure your application is being addressed, and we actively communicate status updates to you.
  5. You’re typically credentialed in 30 – 120 days, depending on the insurer and the timeliness of the information you provide.  

How do I decide what insurers to work with or what panels to be on?

The insurers you work with should be determined by your patient mix and the direction in which you want to expand your business.  You tell us who you want to work with, and we can provide guidance on the best approaches to get enrolled.  We’ll also be happy to provide guidance on how to leverage panel enrollment for business growth.

What insurers do you currently work with?

Basically, all of them.  We have well-established relationships with Medicare and Medicaid, Blue Cross, Blue Shield, HAP, Aetna, United Healthcare, Cigna, Humana, Priority Health, Meridian, Beacon Health, McLaren, Magellan, Optum, Molina, HAP Midwest, Aetna Better Health, Health Plus, Health Net, Tricare, Fidelis, Humana, AmeriHealth, Kaiser, Anthem, Coventry, Cofinity and many others.

How long does it take to be credentialed?

Unfortunately, it depends.  Each insurer has different processes and different resources in place to support panel enrollment.  As a result, it generally takes about 60 to 120 days to be fully enrolled.  Because of our understanding of each insurer’s credentialing process and established relationships, we can usually significantly reduce the time it takes to be approved and enrolled.

Do you have experience with my specialty?

Yes, we work with almost all medical practice areas, from behavioral health to surgery.

What if the insurance company I want to work with is closed?

Insurers may close a panel to new providers when they feel like they have adequate coverage for a specialty or geographic area.  If you are interested in working with an insurance company that has closed enrollment, we can often leverage our contacts at the insurance company for additional details, and in many cases file an appeal on your behalf to get you enrolled.  This is entirely at the discretion of the insurer, and highly dependent on the value you and your practice can add to their policyholders.

Do you offer medical billing services?

We focus on credentialing, but have strategic relationships with several high quality billing companies.  We’d be happy to provide you with a referral.

Ready to increase practice revenue and get your time back?