Physician Credentialing Services

Physician Credentialing Services and Medical Provider Enrollment Services

Physician Credentialing Services with Microwize helps you void all the headaches, stacks of paperwork, and confusion with the insurance companies. Trust the experts at Microwize to help you navigate the difficult process of provider enrollment and national medical credentialing service at a low cost.

One of the most integral elements of running a practice is to get credentialed and maintain your provider’s credential status. Without proper enrollment, payments can be delayed or refused by the insurance carriers, even if the physician is able to provide services that are competent and medically necessary. Ignoring or missing the credentialing process can result in a multi-thousand of loss of income.

At Microwize we offer Physician Credentialing Services, helping providers achieve better revenues. Contact us to get started with Provider Credentialing Services.

Physician Credentialing Services

Why Do Physicians Need Credentialing?

Physician Credentialing is a process of enrollment and validation that a physician is part of a Payer’s network and is authorized to provide services to patients. Credentialing is needed to verify that the physician meets standards as determined by the Payer(insurance company) by reviewing such items as the individual’s license, experience, certification, education, training, affiliations, malpractice & 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 changing from one practice to another

Providers We Serve:

  • Physicians (MD or DO)
  • Physician Assistant (PAs)
  • Nurse Practitioner (NPs)
  • Physical Therapy (PT)
  • Occupational Therapy (OT)
  • Speech-Language Pathologist (SLP)
  • Podiatrists (DPM)
  • Chiropractors (DC)
  • Ambulatory Surgery Centers (ASC)
  • Urgent Care Facilities
  • Diagnostic Testing Facilities (IDTF)
  • Sleep Labs
  • Optometrists
  • Audiologists
  • Behavioral Health Providers

Payer 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

macra-medicare

Initial Registration and Re-validation:

  • PECOS
  • CAQH Registration
  • NPI Registration

Physician 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 

Physician Credentialing Services

Physician Credentialing Process:

1. Kick off/Onboarding

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

2. Facility/Location/Provider Details

Onboarding/practice/provider set up information from your practice

3. Initiate Par/Non-Par Analysis with Payers(s)

Outreach to the payers to verify providers enrollment/TIN

4. Audit of CAQH

Access of CAQH profiles to ensure locations and creds are on file

5. Application and Link Letters

Filling in of any enrollment gaps via application or link

6. Par ID Reporting

Ongoing communication to customer of Par IDs and completed enrollments

FAQ

How Long Does the Physician Credentialing Process Take?

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

Paper Application or CAQH ID submitted to plan. Credentialing steps

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.

Welcome letter sent to practice

Application checked for completeness by Payor

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 service

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)

Need more info?

Call us at 800-955-0321

Call 800-955-0321 or Click below

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