Credentialing & Enrollment Services

Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided. Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in your practice – failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request. Trust Access Healthcare to get you credentialed fasters as we understand the forms required by each payer, and their policies and procedures.

Provider Credentialing:

The process involves the following steps:

Application Evaluation- Completing required documentation and identifying exceptions.
Primary Source Documentation- Verify practitioner/ facility information from physicians.
Outbound Call Center- Obtain missing documents and update the payer’s database.
Follow-up with payers- Follow up on submitted credentialing requests.
Data Entry- Capture data, label, and link images to specific providers/ facilities in the payer’s database.
Maintenance of Provider Data- Update provider information as per policies and procedures, and CAHQ profile.

Provider Enrollment:

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:

Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims
Updating practice’s Pay-to address. Validate and update the provider’s pay-to-address or the billing address
Enrolling in electronic transactions. Our team can enroll providers for four types of electronic transactions:
- Electronic Data Interchange (EDI)
- Electronic Remittance Advice (ERA)
- Electronic Fund Transfer (EFT) and
- CSI
Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

Provider Credentialing & Enrollment Services Allow you to:

Keep your data up-to-date with payers
Process faster payments from insurance and get more patient referrals
Mitigate revenue leakage
Avoid piles of paperwork and filling out application forms
Reduce denials and identify provider trends
Build relationships with different payers.

Receive real-time status of credentialing and enrollment transactions.

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