Physician Credentialing is a process of formal recognition and attestation that a physician is both qualified and competent to provide services. By examining factors including the person's license, experience, certification, education, training, malpractice and adverse clinical occurrences, clinical judgment, and character through inquiry and observation, credentialing confirms that a doctor satisfies requirements set by healthcare facilities.

Time and again new practices invest countless hours and money on office space, equipment, software, and staffing only to find significant delays in getting adequate insurance reimbursements. More often than not, the problem could’ve been allayed by addressing the physician credentialing process early and thoroughly – creating the necessary relationships with insurance carriers. Effective physician credentialing services are the absolute necessity for better performance of the practice. Without proper enrolment, payments can be delayed or refused by the insurance carriers, even if the physician is otherwise ready and able to provide services.

We at RCM Billing Services help you by taking away all these hassles from you and also preventing delays and denials in getting your insurance reimbursements by providing complete physician credentialing services and making sure you get what is rightfully yours.

• Preparing CMS 855 and other Managed Care forms on paper for each Payer.
• Preparing and submitting online applications to non-governmental and federal carriers.
• New provider affiliations and Group Contracts
• Keep track of and update particular Provider data directly with carriers on a regular basis or upon request.
• Handle enrollment problems and monitor Managed Care agreements.
• Validate information provided by Payers
• Handling Provider letter of interest & enrolment transactions
• Setting of Provider information in the Practice System
• Obtaining Contracted fee schedules and negotiating changes
• Preparing contract documents for scanning and electronic long-term storage.
• Managed care summaries that include effective dates, a fee schedule, and group affiliation should be created, maintained, and tracked.
• DEA, CLIA, and NYS registration expiration dates are tracked, and reapplications for the same are managed.
• Handling Re-Credentialing whenever required.
• With our physician credentialing services, we guarantee that your credentialing application receives the consideration it merits.