Our credentialing Services

Credentialing or enrolling with government and commercial payers is one of the more challenging/frustrating aspects of running and/or starting a medical practice.  As the first nationwide contracting and enrollment company, it’s been interesting to see everyone play catch up and copy most of our services.  We are the innovators in the credentialing space and enjoy being the organization that sets the tone for this industry.  We take care of everything from start to finish and keep you from spinning your wheels on the telephone for hours and hours each day.  We offer physician credentialing services in all 50 states and work with thousands of providers every year. Our team of experts understand how to work with the insurance companies and as former practice managers, we also understand what each insurance contract means to your bottom line.

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 the past 10 years.  In addition to our credentialing experience, we also owned and operated a nationwide billing company until the beginning of 2016 at which time we sold out of this business to focus solely on the insurance side of healthcare. Provider credentialing is a time-consuming process where attention to detail is critical.  Even the slightest error in the application process can cause it to be rejected or delayed which ultimately causes a delay in you getting paid.  We are here to bridge the gap between providers and a payer networks.

Our credentialing service can include any of the following:

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Frequently Asked Questions:

  • When will you start on my project? We will start on your project within 1 business day of receiving the submitted proposal and credentialing information.
  • How long does it take? It typically takes 90-120 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.
  • Can I hold claims and bill once approved? Some payers allow you to do this (primarily Medicare & Medicaid) but most commercial insurance companies do not allow retroactive billing. You can bill as an out-of-network provider while in credentialing if you need to start before all contracts are fully loaded.
  • Can I submit under another physician? This is inappropriate in most situations unless we can justify using a locum tenens modifier. We would make recommendations on a case by case basis.
  • Why I should use PPS for insurance credentialing? There are a number of options out there, but there is only one company like ours. We help hundreds 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 contract which start at $50 dollars per month per provider. This would cover all of your recredentialing needs.

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

Physician credentialing services are typically a great option in the following scenarios:

  • When you outgrow your in-house credentialing 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.

  1. We are an established organization that is currently credentialed but interested in outsourcing our credentialing department to save money and improve efficiency.
  2. I’m opening a new practice and need initial credentialing/contracting
  3. We are a hospital or university in need of enrollment and credentialing maintenance
  4. We’re not interested in outsourcing but have a backlog of credentialing tasks and need to get caught up. 
  5. We are just wasting time reading about credentialing
Summary
Credentialing Services
User Rating
5 based on 3 votes
Service Type
Credentialing 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.