Insurance Credentialing & Provider Enrollment Services

You have enough to deal with, why bang your head against a wall trying to figure out each payer’s credentialing process.  Our experienced team of credentialing experts can take your organization through the entire credentialing process without you ever losing sleep or even breaking a sweat.  We help thousands of providers every year and would love to take this off your plate.  Whether you’re a hospital, multi-specialty group or a solo practitioner, our credentialing services and enrollment technology are designed for your needs.  It’s not a one-size-fits-all approach with our company as we understand that every practice is different and has their own set of challenges that we need to address.  Our leadership is comprised of former executives with extensive knowledge in running and growing medical practices.  This experience, along with our forward thinking and incredible team of professionals, has positioned our company as the leader in the credentialing and enrollment space.

credentialing services

What Enrollment & Physician Credentialing Services We Provide:

We provide contracting and insurance credentialing services to practices and hospitals of all shapes and sizes across the country, and have been doing so for over 10 years.  

  • Payer Enrollment & Credentialing Services

  • Individual & Group Medicare Enrollment

  • Medicaid Enrollment for Group & Individual

  • Insurance Contract Negotiations

  • Payer Fee Schedule Creation & Evaluation

  • Telemedicine Credentialing

  • Lab enrollment services  (CLIA)

  • Medical License Application Processing & Renewals

  • DEA Registration & Renewals

  • CAQH Registration & Enrollment

In addition to our credentialing experience, we have also owned and operated a nationwide billing company until the beginning of 2016.  This when we decided that it was best to sell the company and focus solely on credentialing.  Payer enrollment is a time-consuming process where attention to detail is critical and even the slightest mistake in an application can cause the entire process to halt which ultimately leads to delayed payments.  

Who We Work With

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Urgent Care Facilities
  • Audiologists
  • Behavioral Health Providers
  • Physical, Occupational & Speech Therapists
  • Labs, ASCs & Imaging Facilities
  • FQHCs & Rural Health Clinics
  • Hospitals & Universities

Frequently Asked Questions:

  • When will you start on my project? We will start on your project within 3 business days of receiving the submitted proposal and credentialing information.
  • How long does it take? It typically takes approx 120 days to fully credential a new provider. Some payers only take 30-60 days and others take 150 days. If you have existing group agreements, the process will be much faster because we do not need to wait for the contract to be loaded.
  • What if you do not get me in network with one of the payers? We will continue to appeal until you are in-network.
  • Why I should use PPS? There are a number of options out there, but there is only one company like ours. We’ve been doing it the longest and have the evidence says we’re the best.  We help thousands of providers every year take care of some of the most challenging credentialing situations out there.
  • What are the terms of our agreement?  Our agreements are for a period of 1 year or until we’ve completed everything.
  • What happens after the first year? After the initial enrollment project is complete, you would have the option to move over to a maintenance agreement which varies in price but is typically between $40-$60 per provider.  This would cover all of your recredentialing needs.


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What is Physician Credentialing?

Physician credentialing often used to mean to process providers undergo to participate with insurance companies otherwise known as provider enrollment.  Simply put, it’s 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 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.

Summary
Insurance Credentialing, Contracting & Provider Enrollment Services
User Rating
4.5 based on 279 votes
Service Type
Insurance Credentialing, Contracting & Provider Enrollment Services
Provider Name
Physician Practice Specialists,
4600 Touchton rd., Building 100, Suite 150,United States-32246,
Telephone No.800.406.4796
Area
United States
Description
Provider enrollment and credentialing services for healthcare organizations nationwide.