Medical provider enrollment and credentialing is a tedious and long process of verifying a healthcare professional’s qualification, training, medical license details and national provider identifier number (NPI). It’s an essential step for a healthcare practice in order to be enrolled and contracted for providing medical care services to a specific health insurance plan e.g., Medicare and Medicaid, etc.
After a physician is enrolled in an out-of-network or in-network plan, they are allowed to treat patients who have obtained or purchased healthcare insurance from a certain insurance company. Doing this process on your own is only difficult but may put provider enrollment applications filled with errors, consequently denied. Outsourcing a professional company offering credentialing for healthcare providers in Vermont not only helps in this entire process but also fast tracks your application.
Healthcare credentialing services acts as a life-line to medical practices because:
Physician credentialing services ensure a provider is trained, has relevant education, experience and license to treat patients coming to their clinic/hospital.
Insurance credentialing services confirm that a physician is following ethical standards like handling patient’s sensitive information with care and preserving confidentiality.
Credentailing helps clinicians in building trust between their practice and patients. Patients are more likely to discuss their disease with providers who are credentialed.
Payer credentialing services play an integral part in your practice’s ability to bill government and commercial insurers. Without it, providers lose access to insured patients.
Medical staff credentialing allows providers to appear as an approved healthcare center in directories, helping providers to increase their patient base.
Our provider enrollment services assist physicians in obtaining their NPI number from CMS and submit credentialing applications for creation of profile on CAQH Proview and its long-term maintenance, upgradation. CAQH profile allows practices to submit their application to different insurance panels.
Provider contracting services we offer help Vermont-based providers to submit their application after creating their profile on CAQH Proview. Our credentialing support staff help medical professionals in the application process and make it error-free. We provide regular follow-ups to physicians.
Insurance enrollment services we offer are tailored for medical practitioners and assist them in easy enrollment with Medicare, Medicaid, and commercial payers in Vermont. After getting enrolled, providers may start treating patients holding these health plans and get paid for it.
Beside helping individual providers in credentialing, we also provide full service support to large hospitals and facilities offering multiple treatments like diagnostic, radiology and pharmacy services. Our medical credentialing services in Vermont also help providers in getting hospital privileges by referring chronic disease patients.
Our medical credentialing staff diligently help healthcare providers in payer contracting with Medicare, Medicaid and commercial payers like UnitedHealthcare, Humana, Blue Cross Blue Shield, etc. Our team helps practices in negotiating best and favor terms in reimbursements and out-of-contract payments.
Beside offering credentialing and payer contracting solutions, we also help healthcare organizations in re-credentialing and compliance. Our ongoing maintenance assists providers in maintaining the NCQA compliance standards to keep getting referrals from insurance companies, increasing their patient pool and revenue as well.
Our most trusted provider credentialing services are well-suited and tailored for more than 50 healthcare specialties and practices including:
Physicians
(primary care, specialists).Nurse
practitioners & physician assistants.
Behavioral
health providers.Dentists,
chiropractors, podiatrists.Small clinics
& large group practices.Rural health
and community healthcare clinics98%+ coding accuracy
rate
AAPC & AHIMA certified
codersDedicated coding
account managerFast turnaround (24–48
hrs for most claims)
Local knowledge of
Vermont payers and billing workflowsHIPAA & SOC2
complianceDaily audits and
revenue leakage prevention
No hidden fees –
transparent pricingExperienced and
certified coding team (CPC, CCS, CCS-P)Proven track record in
reducing denials and improving collections
U.S.-based and
specialty-trained codersAt Vermont medical billing company, our provider medical credentialing process contains the following steps:
We conduct detailed interviews with physicians to gather essential information such as license numbers, academic background, and professional history for obtaining NPI (National Provider Identifier).
Based on a practice’s location, we help providers in choosing government or commercial insurance plans matching their goals, specialty, license type, etc.
Our team handles the CAQH (Council for Affordable Quality Healthcare) application, its submission, and the ProView account to make your credentials up-to-date for smooth primary source verification.
Our delegated credentialing experts take result-oriented steps in minimizing the timeline of the process by relying on precision, resulting in 20% less time.
Our fast-track Insurance credentialing process results in providers getting offers for in-network Medicare enrollment, resulting in successful billing by getting your practice added in the provider directory.
After successful network participation agreements, we help you gain maximum hospital privileges, including inpatient treatments, encounters, and surgical rights. Payor contracting strengthens revenue cycle management (RCM).
HIPAA-compliant medical billing services for Vermont providers, increasing efficiency and lowering reimbursements delays.
Timely insurance eligibility verification checks to make sure providers will get reimbursement on services.
Medical credentialing enables providers to get Medicaid enrollment and get privileges.
Fast-track payer contracting allows providers to offer medical care to a variety of patients.
Long delays in
application approval
In-house
team’s inefficiencyMissing
information (NPI, In-complete CAQH
profile, etc)Less
information about credentialing process
Non-compliance
with CMS policies
Contact us today for credentialing support and payer enrollment assistance.
Our medical credentialing services entails the following:
Typically the entire process of credentialing, getting CAQH profile maintenance, enrollment and contracting process may take up to 90-120 days but may take longer since the time varies carrier to carrier and requirement for detailed information may change from time to time. Small insurance companies may even take longer due to less resources for background checks, etc.
Credentialing is the step that is taken in order to verify a provider’s qualifications and competence, while enrollment registers the provider with insurance payers to bill for services rendered in the name of medical care.
Recredentialing is the periodic renewal of your enrollment status with insurance payers before the expiration of your credentialing status , typically every 2 to 3 years. Our team manages the entire process and applies for new credentialing approval 3-4 weeks before expiration date.
CYes we do offer credentialing services for solo practices and group practices as well. Our tailored solutions are created as per your needs, facilitating and supporting the revenue cycle of medical professionals.