MS Revenue & RCM Automation
Physician Credentialing
Physician credentialing and provider enrollment services are crucial processes that ensure physicians are part of a Payer's network and authorized to provide services to patients covered by the Payer's plans. Credentialing verifies a physician's qualifications, including licenses, experience, certifications, education, training, affiliations, malpractice history, adverse clinical occurrences, and clinical judgment.
Opting for physician/provider credentialing services is essential for better practice performance. Without proper enrollment, insurance carriers may delay or refuse payments, even for competent and medically necessary services provided by the physician.
At MS Revenue & RCM Automation, we offer physician credentialing services that help providers achieve better revenues. Our services are tailored to different scenarios such as when physicians:
- Begin their first practice after medical school.
- Change from one practice to another.
- Join an existing physician group.
- Seek enrollment with a new Payer.
Each Payer has its own set of forms for enrollment, either online or in paper applications. We ensure diligent follow-up with Payers to expedite the provider credentialing process, avoiding any negative impact on revenues.
Our Physician Credentialing Services include:
- Handling provider letters of interest and application requisitions from Payers.
- Assisting with new provider affiliations and group credentialing.
- Managing facility credentialing, including adding providers to facility IDs.
- Preparing paper CMS 855 and Managed Care applications for all Payers, including DME and dental Payers.
- Submitting online applications to federal, state, and commercial carriers.
- Maintaining and updating specific provider information directly with carriers at frequent intervals or when requested.
- Resolving enrollment issues and tracking managed care contracts.
- Preparing, maintaining, and monitoring managed care summaries, providing effective dates, fee schedule details, and group affiliations.
- Monitoring expiry dates for NYS registrations, DEAs, and CLIA registrations, and handling re-applications.
- Handling re-credentialing as required.
Our dedicated team of physician credentialing specialists ensures that your credentialing application receives the attention it deserves. We make the entire process seamless, saving you time and effort.