Medical Credentialing Services

Quick and easy medical credentialing in just a few short steps.

Medical Credentialing

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.

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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
  • Internship/Residency/Fellowship’s 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

1. What should you expect from your Credentialing 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 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 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 Credentialing process take?
The 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 CREDENTIALING SERVICES

Using PrognoCIS Medical Credentialing Services, you receive:

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Credentialing specializing in all 50 states

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Save time and let us do the paperwork for you

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Team of experts to navigate paperwork

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Assistance with appeals for panel closures

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Cost savings so that you and your team can do what they do best–take care of your patients!

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Major medical provider enrollment; Medicare and Medicaid enrollments for group and individuals

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Updates on credentialing status within 24 hours

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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.

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What is Credentialing (0:46)

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The Dos (5:51)

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The Don’ts (15:00)

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How PrognoCIS Can Help (27:08)

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Questions (27:48)

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.

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Hospital credentialing and CVO services

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New Credentialing and Medicare Group Enrollment

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Medicare Individual Enrollment and Medicare Revalidations

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Medicaid Group Enrollment and Medicaid Individual Enrollment

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Re-Credentialing and Demographic Updates

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Yearly Maintenance and DME Credentialing

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Facility Enrollments

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