Medical Credentialing Services

Quick and easy provider credentialing in just a few short steps. Comprehensive Solutions for All Healthcare Practices 

credentialing physicians

Provider Credentialing Service From Prognocis Expert

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 providers 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
  • Internship/Residency/Fellowship’s Information
  • Board Certifications
  • Provider’s CV

By signing up for our physician 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 service “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 Provider 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 physicians 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.

Medical Provider Credentialing Process

Credentialing Process flow
  • The medical provider credentialing process requires involvement from the healthcare provider, the organization, and the payer.
  • The organization typically provides the healthcare professional with the credentialing application(s). He or she is responsible for completing the application – which may be many, many pages long – and attaching all requested documentation like board certification, college degrees, and more. When the application is complete, the provider submits it to the organization he or she plans to provide services under.
  • The organization is then responsible for attaching additional documentation: any claims history, background screen results, primary source verification, and more.
  • Once they’ve completed any healthcare facility portions of the application and attached appropriate documentation, they submit the completed application and supporting documentation to the payer.
  • The payer reviews the application to determine whether the healthcare provider meets the payer’s standards. Things they’ll take into consideration include the provider’s education (and accreditation of that program), residency or fellowship, recommendations, malpractice claims history, license, and more.
  • This entire process is required when the provider first joins a new practice and then periodically thereafter – usually every two to three years depending on the payer.

What Information is Required for Credentialing?

Information is dependent on payers but tends to be relatively consistent across the board and typically includes:

• license to practice and primary source verification
• NPI number
• DEA license
• work history
• degrees and transcripts
• references from previous employers/practitioners
• insurance information
• board certification
• malpractice claims history
• license history (suspensions, revocations)


Credentialing Your New Medical Practice?

Outsourcing Credentialing and Re-Credentialing

When you elect to handle credentialing physicians in-house, you must assign resources to compile and send out application materials to new providers; track the completion and collect the documents; complete the facility portion of the application and credentialing process (like primary source verification, malpractice claims review, etc.); send the applications to payers; and then respond to any requests for corrections or additional information from payers. Additionally, that person (or team) must track re-credentialing deadlines and initiate, track, and complete the process every time a provider is due for re-credentialing.

Most importantly, they must develop and maintain expertise in the provider credentialing process, including staying abreast of changes in the industry, credentialing trends, and payer requirements.

Re-Credentialing

Lack of expertise among the credentialing team can lead to denied applications or requests for more information from payers, which can extend the time from offer to start for a new provider – and delay delivering services to patients who need them. For this reason, many healthcare organizations choose to outsource credentialing services for physicians to an expert third party vendor. PrognoCIS is one of these vendors.

As experts in medical provider credentialing, we take on the credentialing process from start to finish. That means that all of the responsibilities that would typically fall on the facility can be completed by the team at PrognoCIS, freeing up your team for more important work. We work with the provider to get the initial application completed, perform the due diligence tasks required of the organization like primary source verification and background screening, and coordinate with payers to support timely approval and expedite provider starts.


Learn more about Outsourcing Medical Provider Credentialing, contact the team of experts at PrognoCIS 

Why Choose a Credentialing Service?

Clients often share that they can’t afford to outsource credentialing physicians, but after a review of the expense of managing the medical provider credentialing process in-house, find that outsourcing provides savings for the organization.

When you outsource your medical provider credentialing to a team of experts, efforts can be consolidated; where your team might be credentialing one or two (or twenty) providers at a time, our team is credentialing dozens of providers at once, every single day. This allows us to consolidate steps and save time and money in the process.

1. What should you expect from your Medical Credentialing Service Provider Company?
The process should begin with reviewing your specific network needs or an evaluation of the top payers in your area.  Once final decisions are made, a contract is executed for the work to be done and payment is made.  The Credentialing team gathers all necessary documents from the provider and contacts the insurance companies to begin the application process.  For most companies, the process can be completed online through their portal for form completion.  If not, they will be filled out and then sent via the required method.  After submitting the applications, timely follow-up with the payers is crucial to ensure they were received. We give bi-weekly status updates to the client to keep them informed throughout the process until an effective date of enrollment is determined and a contract is received and executed, so the provider can begin claim submission.
 
2. When you outsource your Credentialing, what does that medical credentialing company provide you?
Outsourced Credentialing companies should respond to requests timely and provide excellent communication and complete transparency.  A provider should work with a company that is professional and caring, taking ownership in the process as your representative in dealing with the insurance companies.  
 
3. How does PrognoCIS provide a complete physician credentialing service?
We assign them a Credentialing representative that they can communicate easily with and rely on.  We offer to analyze their payers for their specialty and geographical location, as well as evaluate their contracts.  We want providers to feel as though we are sitting in their office and are available when they need us. 
 
4. How long does the provider credentialing process take?
The physician credentialing process generally takes between 90-120 days. We send a checklist of all documents that are required so that we can begin.  Once they are received, we upload your data into our system and work to get your applications completed and submitted to insurance companies. We then follow up regularly with insurance companies to make sure that your credentialing applications are received and being processed and approved without unnecessary delays.
 
5. Do you have experience credentialing my specialty or for providers in my area?
Yes, we have credentialed for providers across the United  States, including Hawaii, and for a variety of specialties and practice sizes!  
 
6. Do you offer any service to keep up the documents and insurance contracts that expire and must be renewed?
Our Re-Credentialing and Maintenance package tracks expiration dates and renewals of contracts for your networks, such as BCBS, Aetna, and Cigna, as well as the various plans you are enrolled with under their umbrella, including Medicare and Medicaid re-validations.  We also provide CAQH maintenance and attestation every 3 months, notifying the provider of expiring documents such as Malpractice, License, DEA, etc.

Benefits Of Physician Credentialing Services

PrognoCIS Credentialing Services for Physicians, offers you the following :

  • Credentialing specializing in all 50 states
  • Team of experts to navigate the paperwork
  • Cost savings so that you and your team can do what they do best–take care of your patients!
  • Updates on credentialing status within 24 hours
  • Save time and let us do the paperwork for you
  • Assistance with appeals for panel closures
  • Major medical provider enrollment; Medicare and Medicaid enrollments for group and individuals
  • Payments from third-party payers arrive much quicker
medical credentialing team

Other Credentialing Benefits: 

physician referralThe organization can’t bill for the services a professional provides unless that professional has been approved by all payers through the credentialing process. This makes medical provider credentialing a foundational task as providing services that can’t be billed is not feasible or sustainable for the organization.

The credentialing process ensures that the provider meets the standards of the organization and the organization’s payers, identifying risk factors early and reducing the risk of adverse outcomes. As a result, credentialing improves the patient’s trust in their provider and healthcare organization, protects hospital revenues, limits risk of potential loss, and improves the practice’s reputation overall.

Although credentialing can be time-consuming, delaying the onboarding of new providers and requiring facility resources to process and support, the benefits outweigh the risks in every case.

Also Read- Medical Credentialing Tips and Best Practices

The Dos & Don’ts of Providers Credentialing and Enrollment Services

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)

  • Questions (27:48)

Medical Credentialing Services 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.

  1. Hospital credentialing and CVO services 
  2. New Credentialing and Medicare Group Enrollment 
  3. Medicare Individual Enrollment and Medicare Revalidations 
  4. Medicaid Group Enrollment and Medicaid Individual Enrollment 
  5. Re-Credentialing and Demographic Updates 
  6. Yearly Maintenance and DME Credentialing 
  7. Facility Enrollments

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