Credentialing or enrolling with government and commercial payers is challenging any way you slice it, but we’re here to eliminate the stress and increase the efficiency.  As the first nationwide contracting and enrollment company, everyone else is still trying to play catch-up with 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.  We offer physician credentialing services in all 50 states and work with thousands of providers every year.  Our team of experts understands the insurance companies, and as former practice managers, we also understand what these insurance contracts mean to your bottom line.  We provide contracting and insurance credentialing services to practices and hospitals of all shapes and sizes.

What are physician credentialing services?

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 may assist individuals under the following scenarios:

  • When they are planning to start a new practice or are adding a new practice location
  • When joining a new practice or relocating
  • When they are planning to bring in a new provider to their existing group
  • When changing TAX ID
  • 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. After all, these scenarios often arise even if the physician is competent to provide his/her services to patients.

Secondly, different insurance carriers have their own requirements when filling out their forms. This process requires due diligence and follow up to ensure that the payer’s credentialing process is attended to within the shortest time span possible. Otherwise, this process will always have an impact on revenue collected.

Outsourcing your provider credentialing department frees the physician, provider and/or administrator of valuable time and ensures an efficient provider enrollment process.  An expert in credentialing services would also assist the physician in requesting or obtaining annual fee schedules which ensure that reimbursements are in line with the contracted rates.

Our physician credentialing service and contracting service include the following:

Why Use Us

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. 

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 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.