Medical Credentialing & Insurance Enrollment Services

Physician Credentialing & Insurance Enrollment Services

Professional Medical Provider Credentialing & Insurance Enrollment Services

Medical credentialing and insurance enrollment can be a major challenge for providers and physicians due to its complexity and time-consuming nature. Without proper enrollment, insurance carriers may delay or refuse payment, leading to significant lost income. Medical credentialing services and insurance credentialing for physicians ensure that your practice runs smoothly and efficiently.

At Microwize, we offer medical credentialing services to help providers simplify their process & achieve better revenues. Contact us to get started!

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medical credentialing services and insurance credentialing for physicians

What is Credentialing & Why Do Doctors Need It?

Physician credentialing is the process of enrolling and validating a physician as a member of a payer’s network, authorizing them to provide services to patients. Credentialing is essential to ensure that the physician meets the standards set by the payer (insurance company). This involves reviewing various aspects such as the physician’s license, experience, certification, education, training, affiliations, malpractice history, adverse clinical occurrences, and clinical judgment.

When Do Physicians Need Credentialing?

• When starting to practice after medical school
• When enrolling with a new payer
• When adding new provider to an existing  group
• When forming a new group
• When starting a new practice
• When changing from one practice to another

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Providers We Serve:

• Physicians (MDs or DOs)
• Pediatricians
• Physician Assistants (PAs)
• Nurse Practitioners (NPs)
• Physical Therapists (PTs)
• Occupational Therapists (OTs)
• Speech-Language Pathologists (SLPs)
• Podiatrists (DPMs)
• Chiropractors (DCs)
• Ambulatory Surgery Centers (ASC)
• Urgent Care Facilities
• Diagnostic Testing Facilities (IDTF)
• Sleep Labs
• Optometrists
• Audiologists
• Behavioral Health Providers

Medical Credentialing for Physicians – Pricing Information & Cost Breakdown

INDIVIDUAL PROVIDER PLAN
$200 per application
On-boarding provider
Initiate par/non-par analysis with payer(s)
Outreach to payers to verify provider enrollment/TIN
Access to CAQH profiles to ensure locations and credentials are on file
Application preparation and submission
Filling in of enrollment gaps via application or link
Par ID reporting
Ongoing communication to customer of Par IDs and completed enrollments
Follow up with insurance network(s) until credentialing is approved
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NEW PRACTICE PLAN New practice with 3+ providers
$1800 per provider
On-boarding practice and provider
Initiate par/non-par analysis with payer(s)
Outreach to payers to verify provider enrollment/TIN
Access to CAQH profiles to ensure locations and credentials are on file
Application preparation and submission
Filling in of enrollment gaps via application or link
Par ID reporting
Ongoing communication to customer of Par IDs and completed enrollments
Follow up with insurance network(s) until credentialing is approved
Credentialing with 12 major insurances for 3 providers
NPI registration and validation (NPPES)
*Additional plans charged at $325 per plan if more than 12 plans are needed. $1,800 per additional provider.
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MULTI PROVIDER PLAN Multi-provider practice with 5-10 providers
$2000 per month
On-boarding practice and provider
Initiate par/non-par analysis with payer(s)
Outreach to payers to verify provider enrollment/TIN
Access to CAQH profiles to ensure locations and credentials are on file
Application preparation and submission
Filling in of enrollment gaps via application or link
Par ID reporting
Ongoing communication to customer of Par IDs and completed enrollments
Follow up with insurance network(s) until credentialing is approved
Credentialing maintenence
*Additional plans charged at $350-$700 per plan if more than 15 plans are needed. $300 per month per additional provider
**Minimum contract period 6 months
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DME/LABS PLAN DME, radiology, independent medical labs
$250 per application
On-boarding practice and provider
Initiate par/non-par analysis with payer(s)
Outreach to payers to verify provider enrollment/TIN
Access to CAQH profiles to ensure locations and credentials are on file
Application preparation and submission
Filling in of enrollment gaps via application or link
Par ID reporting
Ongoing communication to customer of Par IDs and completed enrollments
Follow up with insurance network(s) until credentialing is approved
Enrollment in multiple states for Medicaid or Medicare independent medical labs
Licensing and registration assistance to meet out-of-state requirements
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Frequently Asked Question (FAQ)

How Long Does the Physician Credentialing Process Take?

The average processing time for a new enrollment is 90 days.

steps in provider credentialing

After submission, we follow up on the application every 3 weeks until completion. Despite the requests from offices, daily outreach to the insurance company will not will not speed up the enrollment process.

  1. Paper Application or CAQH ID submitted to plan.
  2. Welcome letter sent to practice
  3. Application checked for completeness by Payor
  4. Once Par IDs have been obtained, they are reported back to the office via a PAR ID

What Services are Included in the Contract?

Because we are a full service provider enrollment company. Included in our pricing model are the following:

  • All Provider Initial and Recred enrollments physician credentialing services
  • Medicaid and Medicare Enrollments
  • CAQH Set-up & Maintenance
  • Provider location updates/moves
  • Verification of providers enrollments (done during onboarding and as issues arise)
  • Provider Demographic Verifications (from payers)

Steps in Provider Credentialing 

Kick off/Onboarding
Discussion of project, establish governance structure and contacts as well as meeting times & frequency, onboarding forms, reporting needs, etc.

Facility/Location/Provider Details
Onboarding/practice/provider set up information from your practice
Initiate Par/Non-Par Analysis with Payers(s)
Outreach to the payers to verify providers enrollment/TIN
Audit of CAQH
Access of CAQH profiles to ensure locations and creds are on file

Application and Link Letters
Filling in of any enrollment gaps via application or link

Par ID Reporting
Ongoing communication to customer of Par IDs and completed enrollments

Insurance Enrollment Credentialing Services With

Commercial Insurance:
• Aetna
• Cigna
• Anthem
• Blue Cross Blue Shield (BCBS)
• TriCare
• Humana
• UnitedHealthcare
• Oxford

& many more…

Governmental Payers:
• Medicare
• Medicare Part B
• Railroad Medicare
• Medicaid

Initial Registration and Re-validation:
• PECOS
• CAQH Registration
•NPI Registration

Medical Credentialing Services Include

 

  • Applications and forms state license verification
  • DEA verification
  • NPI verification
  • OIG exclusion list
  • ABMS verification
  • Background checks
  • AMA profiles delineation of privileges (DOPs)
  • Certificates of Insurance (COIs)
  • ECFMG confirmations peer reference verification facility verification educational verification

Ask us about the full RCM service Medical Billing Service 

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physician credentialing services