Payer Credentialing and Contracting

Credentialing verifies that a physician meets standards as determined by the Payer.  Credentialing entails reviewing such items as the individual’s license, experience, certification, education, training, affiliations, malpractice & adverse clinical occurrences and clinical judgment.
 
Effective provider credentialing services are the absolute necessity for better performance of the practice. Without proper enrolment, payments can be delayed, decreased or refused by the insurance carriers, even if the physician is able to provide services that are competent and medically necessary. Reimbursement comparisons per code per payer is vital to optimize revenue
 
Elitaz offers Physician credentialing services, helping Providers achieve better revenues. Our credentialing services facilitate the payer enrollment process when Physicians -

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• Begin the first practice after Med school

• Change from one Practice to another

• Adding New Physician to an existing Group

• Want to get enrolled with a new Payer

 

Different Payers have their own set of forms to be filled either online or through paper applications. Once submitted, there should also be diligent follow-up with the Payers to ensure that the provider credentialing process is completed in the shortest time so that the revenues are not impacted.

The following process is followed as part of Elitaz’s physician credentialing services:

 

• Handling Provider letter of interest and application requisition from Payers

• New provider affiliations and Group Credentialing

• Facility Credentialing including addition of Providers to the Facility’s ID

• Preparation of paper CMS 855 and other Managed Care applications 

• Preparation and submission of online applications to federal, state and commercial carriers

• Maintain and update specific Provider information directly with carriers at frequent intervals or when requested

• Prepare, maintain and monitor Managed Care Summaries that Provides Effective dates, Fee Schedule details and Group affiliation.

• Monitoring Expiry dates for NYS-Registrations, DEAs, and CLIA registrations and handling re-applications

• Handling Re-Credentialing whenever required

 

We ensure that your credentialing application gets the attention it deserves with our dedicated team of physician credentialing specialists