Expert Credentialing Support
Specialized Credentialing Exclusively for Inpatient Facilities & Practices
Claimocity serves as your dedicated partner, delivering credentialing that allows you to focus on clinical workflows and patient engagement. Navigating the intricacies of credentialing can be confusing and may jeopardize your practice financially if mishandled. Claimocity offers a variety of credentialing support services customized to the needs of our RCM service customers to make the process easy, understandable, and predictable.
BENEFITS
- Secure in-network reimbursements
- Accelerated initial credentialing for quicker patient engagement
- Expedited resolution of billing-related issues
- Timely fulfillment of all deadlines and requests
RELIABLE SUBJECT MATTER EXPERTISE
- State, payor, and specialty expertise
- Integrated with your billing team
- Team knowledge and information sharing
- Use of specialized credentialing software
- Proprietary tracking workflows
- Continual process improvement
Services
Portal Management
- NPI, CAQH, PECOS systems oversight
- Insurance-specific portal oversight
- Registration, updates, revalidation, documents
Practice & Provider Document Management
- Document maintenance and repository
- Key expiration dates
- Alerts
Insurance Credentialing & Contracting
- Contract and fee schedule requests
- Letters of Intent (LOI)
- Practice and demographic changes
- Group enrollments
- Provider adds
- New applications
- Contract management
Frequently Asked Questions
Why should I outsource credentialing?
Our team of expert Credentialing Specialists is well-versed in the intricacies of the credentialing process, including state and payor-specific rules. This expertise enables our team members to efficiently and accurately complete credentialing tasks, surpassing those who may lack such comprehensive knowledge.
What information do I need to prepare to get started with credentialing services?
Claimocity will provide a list of both practice and provider documents required by credentialing bodies to process the various types of requests. Additionally, access to existing payer portals will be required upon service initialization.
How long does it take to credential a new provider in the practice?
The application process typically requires less than a week with all the proper documentation in place. For practices with existing active insurance contracts in good standing, the payer consideration process can span anywhere from 30 to 180 days. Medicare and Medicaid typically require less than 60 days (subject to state and third-party administrator specifications).
What is the credentialing process for Physician Assistants and Nurse Practitioners?
The process remains largely consistent across all providers. However, the information being verified, such as credentials and certifications, may vary depending on the provider type.
How does contracting work?
After the credentialing process is finished, providers may be offered a contract to accept patients covered by the respective insurance. Practice Administrators are tasked with meticulously reviewing the contract details, assessing the legal language, rates, specifics, and obligations outlined within. Upon acceptance by the practice, the contract is countersigned by the Insurance Company. Subsequently, the practice and providers are provided with an effective date and provider number, facilitating the commencement of billing to the plan and receipt of in-network reimbursements.
How are payor re-credentialing/revalidations handled?
On average, payors require re-credentialing every 3-5 years. Leveraging our capability to document the due dates for these revalidations and re-credentialing processes, we can effectively prevent unnecessary terminations with payors, thereby minimizing payment gaps.