Credentialing or enrolling with government and commercial payers is challenging any way you slice it, but we’re here to eliminate the stress and paperwork associated with the process. As the first nationwide contracting and credentialing company, everyone else is still playing catch-up to our services and technology. We take care of everything from start to finish and keep you from spinning your wheels on the telephone for 4 hours a day just to be told the same thing you were told 4 weeks ago. We offer physician credentialing services in all 50 states and work with thousands of providers every year. Our team of experts understand the different nuances of each insurance company, and with a senior team of former CFOs, 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 over 10 years. We are the only nationwide company to achieve and maintain an A+ rating by the BBB for the past 5 years.
When do you need a physician credentialing service?
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, which would mean delayed or loss of revenue altogether. This is also the reason why PPS and our credentialing service exists today. We are here to bridge the gap between physicians and a payer’s network.
Physician credentialing services are typically a great option in the following scenarios:
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
Credentialing services are an absolute necessity for any physician or provider who wants to optimize the performance of their practice. Proper enrollment ensures that payment is not delayed or denied by the insurance carrier. In addition, different insurance carriers have their own requirements when filling out their credentialing applications. This process requires extreme attention to detail and consistent follow-up to ensure that the payer’s credentialing process is attended to within the shortest time span possible. If not, your revenue and ultimately the success of your practice will be in jeopardy.
Outsourcing your provider credentialing department frees the physician, billing staff and the administrator of time that they should be spending on other pressing issues. Unless you consider yourself a pro, there is no sense in wasting twice as much time as required trying to do it yourself. An expert in credentialing and contracting will also be able to assist the physician in requesting and obtaining the payer’s fee schedules which to ensure you’re not being underpaid based on current market rates.
Our physician credentialing service and contracting service include the following:
- CAQH Registration
- Commercial Insurance Credentialing / Physician Credentialing (Overview of Credentialing Process Here)
- Managed Care & Government Payer Credentialing
- Workers Compensation Credentialing
- Medical License Application Processing & Tracking
- DEA Registration & Tracking
- NPI Registration (Type I & Type II)
- Individual Medicare Enrollment
- Medicare Enrollment for Group & Reassignment
- Commercial Insurance Contracting
- Insurance Contract Negotiations
- Payer Fee Schedule Creation & Evaluation
- Management of all Credentials
We have been providing this service to clients nationwide for nearly 10 years. 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.
- When will you start on my project? We will start on your project within 2 business days of receiving a signed proposal and your 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 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 all services are complete, whichever comes first.
- 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.