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.
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
- Behavioral Health Providers
Payer Enrollment Credentialing Services With:
- Blue Cross Blue Shield (BCBS)
- Many More…
- Medicare Part B
- Railroad Medicare
Initial Registration and Re-validation:
- 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 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
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.
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
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)