What is Credentialing?
Physician credentialing is also referred to as Primary Source Verification which is the process that hospitals, health plans, and other facilities go through to verify the credentials of a particular physician or provider. Physician credentialing is also often used interchangeably to mean provider enrollment with the insurance companies.
Regardless of your needs, PPS is equipped to assist your organization with the challenges of insurance enrollment and credentialing. enroll or credential hundreds of providers every year with insurance plans across the country. Whether it is Medicare, Medicaid, the various commercial insurance plans, or even the various worker’s compensation networks, our team of enrollment & credentialing 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 credentialing/contracting company, our team of experts has the experience necessary to get the job done right the first time. Our credentialing service is used by thousands of providers across the country each month.
How long does insurance credentialing take?
We oftentimes get the question, how long does it take? Well, to be honest, this is a question that is very difficult to answer. The time to enroll a physician or provider that is already enrolled with a health plan is very different than that of a provider that has never participated with an insurance company. In addition, if the tax id is not affiliated with the health plan then you have to consider that the tax id also needs to be contracted before linking the provider to the new group. If you’re an existing group with contracts in place, then we wouldn’t need to go through the initial contracting process but would need to credential the new provider and link them to your established group. With all of this being said, the time frames vary between 60-150 days depending on your unique scenario. This is why we like to have calls with all of our potential clients to ensure we set realistic expectations in terms of the project’s time frame.
Our clients include major hospital systems, large multi-specialty groups, single specialty groups, solo practitioners, nurse practitioners, physical therapists, behavioral health specialists and everyone in between. We focus on getting you enrolled quickly to eliminate any delays in payment.
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.
We specialize in the following for nurse practitioners, physician assistants, therapists, physicians, and facilities:
Insurance enrollment / credentialing services
Medical license applications and renewals
Insurance contracting and negotiations
CAQH creation and maintenance services
Medicare & Medicaid enrollment and revalidations
DMEPOS enrollment and revalidation
CLIA enrollment services
DEA registration & Medical licensing service for providers
Primary Source Verification