Credentialing and Enrollment

Credentialing and Provider Enrollment

The process of authenticating a provider’s qualifications is termed credentialing.
Credentialing verifies documents and assures that the providers can provide care to patients.
In the past few years, the process has emerged as one of the best ways to protect the integrity of the healthcare profession.

CAQH

The CAQH Provider Manual is 190 pages. Providers do not have the luxury of time to set up and maintain this profile.

However, it's a requirement of many commercial and private insurances. Eastern Medical Billing provides the best and most cost-effective credentialing service that appropriately fulfills all your business needs. The whole process is carried out by our experienced and professional experts.

Our end-to-end services like initial credentialing, re-credentialing, notifying you of any expiring documents, and maintaining your CAQH profile make us our customer’s first choice.

What is required to begin credentialing?

Licensure
NPI Enrollment
Group NPI vs Individual NPI
PECOS Enrollment if credentialing with Medicare
Liability Insurance

How long does credentialing take?

A lot depends on how promptly the Insurance company or the payer responds back to the application. There is no set standard that they follow.

So it is very difficult for a Credentialing company to guarantee that the application process will be completed in 45, 60, or 120 days. However, there are certain things that help expedite the process.

One – Work with someone who has experience in sending applications so they know what documents will enable a “full information packet” so the payers don’t come back asking for more info which usually delays the process. Obviously, multiple back and forth will substantially increase your time for credentialing.
Two – The team should regularly follow up with the payers so they are acting on it quickly and it doesn’t get deprioritized.
Three – Double-check all information you are providing when filing the application. We find this problem frequently that the information we receive is incorrect and it results in application delays.