Credentialing is the process of verifying a provider’s qualifications to ensure that they can provide care to patients. Most health insurance companies require this process including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.
The Credentialing process is completed by verifying all of a provider’s documents to ensure that they are valid and current. These include their medical license, malpractice insurance, and DEA.
Additional information necessary to complete credentialing:
- Medical School information
- Board Certifications
- Provider’s CV
By signing up for our medical credentialing services, we can assist you with provider enrollment and becoming an in-network provider so that you can receive reimbursements from each carrier. While just a few years ago healthcare professionals considered medical credentialing “optional” for building a practice, today it has become more necessary than ever for providers to be in network with insurance companies. Learn how PrognoCIS can help you get the proper credentials to open a medical practice.
The PrognoCIS Credentialing team delivers a knowledgeable and comprehensive service to assist you in becoming an in-network provider with the insurance carriers that you want to participate with. We can give you recommendations by performing an analysis for your specialty and service area if you need guidance.
We also provide services to existing practices. Credentialing is an ongoing process and must be redone every 3 to 5 years. PrognoCIS offers a service that will complete re-credentialing, notify you of expiring documents and maintain your CAQH profile.
When you have gathered your documentation and are ready to get started, contact us. We work with practices both large and small, including solo practitioners as well as large 30+ provider practices as well as 1 and 2 provider practices for both Medicare, Medicaid, and Commercial Payers for a group and individual enrollment. Our team has extensive knowledge and expertise for multiple specialties and services, including DME.
Most Asked Credentialing Questions Answered
BENEFITS OF CREDENTIALING SERVICES
Using PrognoCIS Medical Credentialing Services, you receive:
Credentialing specializing in all 50 states
Save time and let us do the paperwork for you
Team of experts to navigate paperwork
Assistance with appeals for panel closures
Cost savings so that you and your team can do what they do best–take care of your patients!
Major medical provider enrollment; Medicare and Medicaid enrollments for group and individuals
Updates on credentialing status within 24 hours
Payments from third-party payers arrive much quicker
The Dos & Don’ts of Medical Credentialing
View the complete webinar from our in-house medical credentialing experts or jump to the key points below.
What is Credentialing (0:46)
The Dos (5:51)
The Don’ts (15:00)
How PrognoCIS Can Help (27:08)
Service Options and Details
See what we have to offer below and download the pdf of our Credentialing Services for details. Pricing is available through your PrognoCIS service representative.
Hospital credentialing and CVO services
New Credentialing and Medicare Group Enrollment
Medicare Individual Enrollment and Medicare Revalidations
Medicaid Group Enrollment and Medicaid Individual Enrollment
Re-Credentialing and Demographic Updates
Yearly Maintenance and DME Credentialing
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