DOJ’s New Health Care Enforcement Initiative

On July 13, 2017, the U.S. Department of Justice announced to great fanfare its eighth annual national health care fraud “takedown.” This “largest ever” “takedown” is not what many might imagine — swat teams of law enforcement agents simultaneously rounding up suspects around the country. Rather, it was a press event at Main Justice in […]

How much does physician credentialing cost?

how much does insurance credentialing cost?

How much does physician credentialing cost?  Well, this is a frequently asked question so we thought we’d do a short article on this subject.  There are really two categories of credentialing costs for medical practices and facilities.  These two categories are “internal” and “external” costs.  It’s important to note the costs associated with verifying the […]

Provider Enrollment & Credentialing Positions

physician credentialing job

Our dynamic team continues to grow and we would love to have you join it.  We are looking to hire 2-3 enrollment specialists / account managers and another team leader over the next 2-3 months.  Experience in credentialing / provider enrollment is essential for these positions.  We will help expand your skill level but you should […]

Keys to Evaluating Potential Credentialing Service Providers

credentialing services

What does credentialing or enrollment done right actually look like? This is a question that many of our potential clients ask when evaluating credentialing services.  This is an excellent question and there are a number of factors to consider which we will cover in this article. In addition to the below points, you should also […]

When does outsourcing your credentialing make sense?

credentialing services

As we all know, healthcare facilities exist to facilitate and administer medical care to their patients. While we have advanced like never before in our cure rates, infection prevention, disease management, OR efficiency and nearly every other available metric, the roadblocks to actually running a successful practice have done nothing but increase in size. Every […]

Updated Humana Medicaid Regs in Florida

credentialing services

We received this correspondence and thought it was worth sharing to ensure all Florida groups are aware of the changes.  Please contact us if you have any questions about this or other credentialing concerns.   From Humana: Beginning April 10, 2017, claims will be denied for physicians and healthcare professionals with invalid Medicaid enrollment. To […]

CMAC Fee Schedule Tool


It is not unusual for us to be asked 3-4 times per week about fees and how much the VA or Tricare pays for a particular procedure.  The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule.  Tricare fees are […]

Athena Health Credentialing- Rocky Mountain Youth Clinics

credentialing services

We are excited to announce that Rocky Mountain Youth Clinics, with clinics throughout Colorado, has selected Physician Practice Specialists as their vendor for all enrollment and credentialing needs.  In partnership with Athena Health, we are excited to take on this project and ensure RCMY receives the services and expertise they require.  PPS has been providing […]