Our Services
Credentialing
Credentialing is a detailed process that necessitates extensive documentation and verification to qualify for an insurance network. Practice Claim distinguishes itself as the leading provider of medical credentialing services across the United States. We streamline the credentialing process, allowing you to concentrate on your primary objectives. Our team of professionals manages credentialing tasks effectively, from primary source verification to enrollment in premier networks.
Practice Claim Credentialing Services Features
Application Management
To facilitate a seamless experience, we track all payor applications and contracts until the contract load date.
Payor Application Submission
We handle the completion and submission of all payor applications for our clients to ensure accuracy and timely processing.
Privileging Processes
You can choose for Qualifacts to manage all hospital privileging requirements on your behalf.
Contract Acquisition
We obtain contracts for our clients within their selected market.
PAR Identification Numbers
We will supply you with your PAR IDs along with the effective date(s) once they are issued.
Document Provision
We provide our clients with copies of contracts, fee schedules, and other documents in both paper and digital formats.
Our Medical Credentialing Process
A Guide to Our Expert-Approved Provider Credentialing Process
The provider credentialing process at Practice Claim is more than a standard procedure; it is a certified and validated method that upholds the highest compliance standards. We have achieved a success rate of up to 98% in securing provider approvals in premier payer networks with maximum privileges in their areas of specialization. The process generally consists of the following steps
Conducting a Provider Survey
Our credentialing procedure initiates with a thorough survey. This phase involves detailed interviews with providers, collecting vital information such as license numbers, educational backgrounds, demographics, and professional experience.
Selecting the Insurance Company
Our medical credentialing services assist 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.
CAQH Enrollment and Management
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 rapid insurance panel integration.
Expediting Credentialing Approval
While the standard timeframe is 60-120 days, our credentialing specialists take proactive measures to expedite 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.
Facilitating Hospital Privileges Application
As we conclude the credentialing process, our active support continues. We help you secure all necessary hospital privileges, whether for admitting, courtesy, or surgical rights.
Ongoing Surveillance & Updates
Our continuous monitoring guarantees that your credentials remain current and that you avoid lapses in credentialing. Our specialists meticulously track credentialing expirations and conduct comprehensive daily and weekly checks to keep your status active.
Benefits of Outsourcing Medical Credentialing via Practice Claim
- Enhanced Patient Care
- Decreased Administrative Load
- Proactive Follow-up
- Boosted Revenue
- Ongoing CAQH Monitoring
- Compliance to NCQA Standards
- Proficient Application Completion
