Physician Credentialing Services and Medical Provider Enrollment Services

Physician credentialing services with Microwize help you avoid all the headaches, stacks of paperwork, and confusion with insurance companies. Trust the experts at Microwize to help you navigate the difficult process of provider enrollment and national medical credentialing 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 thousands of dollars in lost income.

At Microwize we offer physician credentialing services, helping providers achieve better revenues.Contact us to get started with provider 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 the standards determined by the payer (insurance company) by reviewing such items as the individual’s license, experience, certification, education, training, affiliations, malpractice, and 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

Schedule a Consultation

Providers We Serve:

Physicians (MDs or DOs)
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

Physician Credentialing – Pricing Information

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

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.

MULTI PROVIDER PLAN Multi-provider practice with 5-10 providers

$1500 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

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

Schedule a Call

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