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CREDENTIALING


Credentialing Services**

Credentialing and Staff Appointment:

  • New provider information sheet set-up
  • Practitioner demographic data
  • Verification of credentials
  • Appointment application process
  • File review and staff appointment
  • Appointment approval letter forwarded to Client

Health Plan Enrollment and Linkage:

  • NPI and provider numbers obtained as necessary
  • Enrollment and linkage applications completed and reviewed
  • Cover letter generated
  • Applications, cover letter, and all required attachments dispatched to insurers and tracked appropriately
  • Follow-up initiated with each plan weekly until enrollment completed
  • Notification of Client upon completion

Optional Credentialing Contract Maintenance:

  • Maintaining active in-network status as a participating provider with all selected insurances
  • Re-attestation of CAQH applications every 120 days, upon provider approval
  • Completion of re-credentialing applications for unlimited number of carriers throughout the year, via phone, fax, mail and email requests, including Medicare/Medicaid revalidations.
  • Working with Client staff on credentialing-related claims issues and problem resolution

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