Insurance Credentialing and Contracts

Credentialing might sound just like a form filling exercise, but it isso crucial as it involves trust that patients can repose on their physicians. It is a tedious and systematic process through which healthcare providers credentials are declared to insurance carriers by filling and submitting physician’s educational details, career history, training experience, residency, and licenses specialty certificates. This process is not just one time activity, and it demands periodic and timely revalidation with payers.

This is so important since improper credentialing leads to revenue loss and helps patients stand a chance to report any risk of medical errors since it is estimated that every year, close to 100,000 Americans die from medical errors. This worrying statistic begs industrial leaders to demand for improved standards of competency and exposure to disciplinary actions against health care workers.

Insurance credentialing process is becoming ever so important in healthcare marketplace as healthcare industries are looking for the cost saving approach to ensure greater patient safety. Reviewing the qualification and experience of healthcare professionals can save healthcare organizations from several liabilities, risk of compliance violations, and unwanted lawsuits.

We collect and review all necessary documentation of a healthcare provider to ensure completeness and accurateness prior to submission of records to the payers.

This relieves your staff and providers of the time-consuming tasks of enrolling and re-credentialing with both government and commercial payers through automated process which triggers if any healthcare providers data to be validated or revalidated in timely fashion.

We also have managed to maintain good relationship with network managers of major insurance companies for negotiation of your existing contracts.