Our Services
Credentialing Services
Credentialing is a detailed process that requires extensive documentation and verification to qualify for an insurance network. Practice Claim differentiates itself as the leading provider of medical credentialing services across the United States. We simplify the credentialing process, allowing you to concentrate on your primary goals
Our Credentialing Services
We provide detailed credentialing solutions customized to fulfill the unique needs of healthcare professionals in different fields.
Provider Credentialing & Re-credentialing
- Checking through all the basic and core qualifications, certifications, and licenses.
- Handling of all paperwork needed for primary source verification.
- Conducting repeated historical checks to meet state and federal regulatory standards.
Payer Enrollment and Attestations
- Networking with appropriate insurance companies for integration into their insurance policies.
- Working directly with insurance companies ensuring you get the best possible deal for your practice.
Re-credentialing & Maintenance
- Prevention of any/ all possible shading of the already deposited credentials by updating them more frequently as needed.
- Regular updates of your credentials ensure they remain active and relevant.
CAQH Registration & Profile Management
- We maintain your CAQH profile and ensure it is up to date with relevant changes.
- This contains updating details, confirming details, and addressing changes to your practice.
- That might require an update to your credentialing file.
Contract Negotiation
- Negotiations of payer contracts to achieve the best possible reimbursement level in the practice.
- The conditions on the terms under which payment is done have to be fair.
- Denial of contracts or appeals management along with negotiations are done.
Hospital Privileges Application
- Application for hospital privileges will be addressed and application with necessary deals will be provided.
- Application for admitting, surgical, or specialty consultative rights will be coordinated.
NPI & DEA Registration
- Individuals (Type 1) and organizations (Type 2) can be provider identifiers of NPIs and help with their management.
- Assistance with registration and registration renewal with the DEA for prescription drugs is also provided.
Our Medical Credentialing Process
The provider credentialing process at Practice Claim is more than a standard procedure, it is a certified and validated method that supports the highest compliance standards. The process generally consists of the following steps:
Conducting a Provider Survey
Our credentialing procedure starts with a detailed survey. This phase involves detailed interviews with providers, collecting information such as license numbers, educational backgrounds, demographics, and professional experience.
Selecting the Insurance Company
Our medical credentialing services help providers in strategically selecting insurance partners that align with their practice objectives and license type, while also finalizing insurance panels based on the practice’s geographic location.
Application Preparation & Submission
We manage the submission of CAQH applications, oversee ProView accounts, and ensure that credentials are up to date to facilitate smooth primary source verifications. Additionally, we assist with payer credentialing submissions, promoting fast insurance panel integration.
Fast Credentialing Approval
While the standard timeframe is 60-120 days, our credentialing specialists take proactive measures to speed up the process. Our team maintains weekly communication with payers, advocating for the approval of your credentialing applications.
In-Network Enrollment
During this phase, you may receive an in-network contract that includes fee schedules and applicable CPT billing codes. With successful credentialing, direct billing is possible, frequently resulting in preferred reimbursement rates for in-network providers.
Continuous Maintenance & Updates
Our continuous monitoring guarantees that your credentials remain updated and avoid delays in credentialing. Our specialists carefully track credentialing expirations and conduct comprehensive daily and weekly checks to keep your status active.
Benefits of Outsourcing Medical Credentialing
Utilizing Practice Claim to assist in completing the credentialing process provides various ways that increase the effectiveness and profit of your facility.
Shorter Approval Times
Due to our expertise, we can complete the credentialing process in the shortest time possible, the majority get approval in about 60-120 days. Regular follow-up measures ensure that your applications are given the necessary attention, hence avoiding any delays.
Improved Reimbursements
The reimbursement rates we manage to achieve from insurance payers enable you to maximize your revenue by earning more in reimbursements. In-network credentialing guarantees preferred payment terms which helps with cash flow and overall profit.
Complete Compliance
Our professionals provide all necessary documents proving your credentials under legal and industry standards, guaranteeing you are exempt from audits, and getting penalties or suffering violations. We follow federal and state standards in the course of the credentialing processes.
Minimized Administrative Tasks
We handle all the forms, all the follow-up conversations, and negotiations so the burden of all the credentialing exercises is lifted off. In a complete service, you do not have to handle administrative tasks but simply provide patient care.
Access to Premium Networks
Once successful credentialing has been done, it allows you to contract with networks and payers that are exclusive thus expanding your opportunities. When people become familiar with your practice and develop trust in them, it results in more patient recommendations and satisfaction as well.
Minimize Claim Daniel
Our extensive procedure in evaluating employees reduces the chances of claim rejections because of incorrect details of providers. The provision of reliable and accurate applications boosts the chances of getting approvals while reducing cases of payment refusals.
Why Choose Practice Claim in Credentialing
Competent and Experienced
We have addressed credentialing in various healthcare sectors for both individuals and large practices and facilities. We take this matter with great seriousness and have built a reputation, a high volume of our clients get through insurance and hospital credentialing easily.
Transparency in Processes
Credentialing is always exhausting but communication is important; we make sure that our clients are informed of every step in the process. Our clients receive regular updates about what has been done, the progress made so far, and what comes next.
Personalized Services
If you are a single practicing doctor or part of a large healthcare practice, we can provide you with the right credentialing services. Our approach is very flexible and focused on providing you with great results.
Committed Assistance
Credentialing experts assist clients in this complex process with individual assistance. We remain at your service, so don’t hesitate to raise any issues, ask questions, and seek professional help.
Continuous Monitoring & Maintenance
It is important to note that credentialing doesn’t end, we provide regular maintenance to keep your credentials up to date. We also manage your practice and make sure that it remains credentialed and compliant without any disruptions in operations.
Credentialing Services We Specialized in
Enrollment in Medicare and Medicaid Programs
We provide Medicare and Medicaid enrollment services by utilizing our expertise in the specific regulations to successfully secure the necessary approvals during the application process.
Commercial Insurance Credentialing
Credentialing with private insurance networks Cigna, Aetna, and United Healthcare is what we manage as well as contract management to obtain favorable reimbursement terms with major insurers.
Hospital Privileges and Credentialing
Innitiv helps in filling applications for hospital rights but is not limited to admitting, consulting, and surgical rights while dealing directly with the hospitals to fulfill all tasks related to your area of specialty.
Group Practice and Facility Credentialing
We also provide clients with practice credentialing services and health center credentialing. In this approach, multiple provider enrollments under a practice can be administered in an efficient manner.
Behavioral Health and Allied Health Credentialing
We offer credentials for practitioners in the field of mental health, physical therapists, and other allied health professionals. Our practice also helps out with payer restrictions for this sort of specialty care.
