Insurance Credentialing & Provider Enrollment Services

What is Physician Credentialing?

Physician credentialing is often used to define the process providers undergo to participate with insurance companies otherwise known as provider enrollment or insurance credentialing.  Credentialing also means primary source verification which is the process of validating that a provider meets the standards set forth by the employer or insurance company. When we mention physician credentialing, we are referring to the process providers must go through in order to see members of the various health plans. The payer must validate that the provider meets the training requirements to see their members.  Once that’s complete, there must be a contract in place between the provider and payer which covers how the provider/organization will be paid for their services.

Regardless of your needs, PPS is equipped to assist your organization with the challenges of insurance enrollment and credentialing.  We enroll thousands of providers every year with insurance plans across the country.  Whether it is CAQH, Medicare, Medicaid, the commercial insurance plans, HMOs, or even the various worker’s compensation networks, our team of enrollment specialists have decades of experience and will ensure your practice receives the care and attention it deserves.  As the first nationwide provider enrollment and insurance contracting company, our team of experts have the experience necessary to get the job done right the first time. 

Should You Outsource to a Credentialing Company?

This is an excellent question and one that we answer for potential clients on a daily basis. Typically, the answer is yes, but there are always exceptions.  Every practice is different and has a unique need when it comes to credentialing and contracting.  Some are very complicated and in difficult markets while others are relatively simple.  View our article on outsourcing here

Common Items We Help With:

• When you outgrow your in-house department or find it difficult to hire qualified staff
• When you are planning to start a new practice or are adding a new practice location
• When you’re joining a new practice or relocating
• When you are planning to bring in a new provider to their existing group
• When you are changing your TAX ID or Group NPI
• When carriers are requesting new or updated information
• When a provider desires to participate with an insurance plan

What are your needs?  Listed below are some additional resources you might find helpful.

• We are an established organization that is currently credentialed with the plans but interested in outsourcing our department to save money and improve efficiency.

• I’m opening a new practice and need to be set up with the health plans

• We are a hospital or university in need of enrollment maintenance

• We’re not interested in outsourcing but have a backlog of tasks and need to get caught up. 

• We are just wasting time reading about credentialing