OUR CREDENTIALING SOLUTIONS

What Are Physician Credentialing Services?

Physician cPhysician Credentialingredentialing is often referred to as Primary Source Verification and is the process that hospitals, health plans, and other facilities go through to verify the credentials of a particular physician or provider, and is also often used interchangeably to mean insurance enrollment.

As a company, Physician Practice Specialists does not provide primary source verification services (verifying credentials), but we do 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 contracting/credentialing company, our team of experts has the experience necessary to get the job done right the first time. Our credentialing service is used by over 1700 providers nationwide and we would love to serve you.

Insurance Enrollment Timeframe

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.  The below article is great if you’re evaluating a credentialing company as a potential partner.

When does outsourcing credentialing make sense?  Click here to learn more

We specialize in the following for nurse practitioners, physician assistants, therapists, physicians, and facilities:

  • Insurance enrollment / credentialing services
  • 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