Credentialing

HEALTHCARE SERVICES – CREDENTIALING 

Provider credentialing, the process of getting providers affiliated with payers, is a critical step in the revenue cycle management. The successful completion of this process enables patients to utilize their insurance cards to pay for all or part of their medical services and enables the provider to get reimbursed for the medical services provided. Therefore, it is important for healthcare providers to get credentialed with maximum number payers so that patients can use their service.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers and following up with them to close the credentialing request. Trust RevExp to get you credentialed faster as we understand the requirements by each payer, their policies and their procedures.

The process involves the following steps: 

Our Provider Enrolment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements

Application Evaluation. 

Completing required documentation and identifying exceptions

Primary Source Documentation. 

Verify practitioner/ facility information from physicians. 

Outbound Call Center. 

Obtain missing documents and updating payer’s database. 

Follow-up with payers. 
Follow-up on submitted credentialing requests. 
Data Entry. Capture data
label and link images to specific providers/ facilities in payer’s database. 
Maintenance of Provider Data. 
Update provider information as per policies and procedures, and CAHQ profil

The process involves the following steps: 

  • Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims 
  • Updating practice’s Pay to address. Validate and update the provider’s pay-to address or the billing address
  • Enrolling for electronic transactions. Our team can enroll providers for four types of electronic transactions: 
    1.       Electronic Data Interchange (EDI) 
    2.       Electronic Remittance Advice (ERA)
    3.       Electronic Fund Transfer (EFT) and
    4.       CSI 
  • Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.