Credentialing

Every healthcare provider is required to enroll in an insurance credentialing process to accept patients with insurance. Hospital credentialing is the most intensive credentialing process for medical providers, repeated more frequently than other credentialing standards, and involving more organization contacts and supporting documents.

Unfortunately, provider credentialing and enrolling with the payers is becoming more difficult with each passing day. With most insurance panels getting overloaded due to the spurt in membership applications and a lot of them being selective about enrolling providers, the process of enrolling your facility is becoming more challenging. One error or misstep within the credentialing process could literally bankrupt your practice.

Under the circumstances, outsourcing your credentialing and enrollment not only looks like an attractive option but also makes financial sense. By outsourcing to a professional organization like TLK Medical Group, you not only reduce the stress level on your current staff but also ensure the top priorities of your organization do not get shuffled to the bottom of the stack.

Provider Credentialing and Enrollment Services

Credentialing of the Physicians / Healthcare providers is essential, i.e., certified and enrolled with the Payer’s network, and authorized to provide services to patients enrolled in the Payer’s plan. Credentialing verifies whether the physician / healthcare provider meets standard clinical care delivery measures, in which the payer verifies that a physician has the proper training, license, experience, certifications, affiliations, malpractice insurance, and adverse clinical events.

Payments to physicians who are not credentialed and enrolled with them may be delayed or refused. As a result, they have an adverse financial impact on the practice. Physicians can take advantage of our Payer credentialing and enrollment services in the following areas:

  • Entering into a new practice or beginning a new one
  • Shifting physician practices from one group to another
  • Join or become a member of new groups or organizations
  • Sign up with new payers
  • Keeping credentialing services up to date.

Our Credentialing Process Consists of the following

  • Compile all the necessary information and documentation required to file credentialing applications from a physician
  • Our document management system stores the documents in a secure environment
  • Make contacts with top payers and understand which claims your practice sends
  • Implement payer-specific formats following a thorough audit
  • Tracking application status with the Payer in a timely manner
  • Inform the physician about the status of the application once the Payer has provided the enrollment number
  • Updates of the documents library for credentialing purposes, on a periodic basis

Our Provider Credentialing Services include:

Renewals / New Registrations of an Individual Provider

  • With the State
  • Provider’s Data Maintenance – Update Management on Payer Systems
  • Contracting Creation and Maintenance

CAQH Attestation

  • CAQH application filing
  • CAQH quarterly attestations
  • Expirations and Renewals
  • Tracking and Analytics

Who we help with Insurance Credentialing

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Urgent Care Facilities
  • Audiologists
  • Behavioral Health Providers
  • Physical, Occupational, and Speech Therapists

Benefits of our Credentialing and Enrollment Services

Our focused credentials and enrollment services offer the following benefits:

  • Acquire credentialing with all significant payers more quickly
  • Enhancing cash flow by reducing denials of claims
  • Increase your patient referrals through the network
  • With our document management system, you won’t have to deal with piles of paperwork
  • Get assistance with completing cumbersome application forms
  • Reduce costs associated with the credentialing process by leveraging our global delivery team
  • Get timely status updates on your applications
  • Adding locations and updating mailing addresses with the payers