Provider Credentialing

Provider Credentialing

When it comes to medical practices, credentialing is a crucial aspect that cannot be overlooked. It plays a significant role in ensuring the provision of top-notch patient care as well as guaranteeing prompt insurance payment.

 

For professional healthcare providers, credentialing is an essential way to prove that they possess the required qualifications and training to handle patients effectively. This process enables insurance companies to evaluate and verify the qualifications and licenses of healthcare practitioners accurately. This, in turn, helps them identify whether providers meet specific requirements before approving claims.

 

At Pro Clinical Solutions, we understand the importance of a streamlined and efficient credentialing process and offer expert assistance to ensure our partners receive optimal service. Our highly-skilled Credentialing Department can manage every step of the process for you, from enrollment through CAQH to ensuring that all necessary documentation is up-to-date and in compliance. Trust us with your credentialing and recredentialing needs, and experience streamlined and hassle-free service.

Initial verification for provider current enrolment status with the carrier
Necessary document retrieval for credentialing including documents validity tracking.
Finishing up the application for initial credentialing as well as recredentialing.
Submitting application for the health plans.
Regular follow ups with insurance carriers for application status check and update until it gets approved.
Post credentialing approval; our team ensures to update the database and Billing system for smooth claim submission and processing to get it paid at very first Submission
Separate database maintenance for the carrier lists and credentialing approvals
Obtaining NPI (National Provider Identifier) numbers.
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