We’ll work with you to ensure you have a variety of popular and effective in-network payors to work with. Our experienced team will determine timelines and open-panel availability with the payors of your choice.
We’ll work with you to gather all of the necessary information to file applications. We pride ourselves in our efficiency and thoroughness to ensure a short turnaround time and accurate filing.
Our team will ensure that the submitted application has been received by the payor and that there are no outstanding requests for changes. We follow up regularly with the payor until the contract comes through and arrives at your office or practice.
When needed, we will submit an extensive appeal when there are closed panels for labs of a particular specialty. We communicate your key points of services and overall history of exceptional patient care. We’re prepared for this challenge, as our team has a high success rate of overturned closed panel decisions.
If you as a provider choose to stay out-of-network with particular payors, or are forced to stay out-of-network due to closed panels, our team will handle out-of-network enrollments and NPI registrations on the payor’s website to prepare your practice to start receiving payments for these services.
We take care of any documentation required by demographic changes, such as a new Tax ID with your payors, updating addresses, changing bank accounts, and any other necessary tax. We’ll set up all ERA and EFT enrollments, as well.
Our credentialing portal manages all of your providers’ and physicians’ credentialing data, and is comprehensive, transparent, and HIPAA-compliant. to ensure we keep your database efficient and accurate.
We maintain and manage any PECOS and CAQH profiles that you may use, making sure all information is HIPAA-compliant and accurately profiled.
CREDENTIALING
Onboarding
Payer Discovery & Application filing & Submission
Payer Follow-up on Application
Contracting / Fees Schedule / Final Approval
Re-credentialing
Trust
Credentialing builds trust with leading healthcare insurance companies.
Reimbursement
Proper credentialing ensures accurate reimbursement for services rendered.
Risk Mitigation
Credentialing ensures that providers fulfill requirements and follow rules, which reduces risk.
Financial Stability
Timely credentialing helps to avoid financial losses due to delayed reimbursements / claims.
Insurance Contracting
Medical Credentialing
CREDENTIALING
Processing time of your application depends on how busy the payor is and also the accuracy of the submitted application. Generally, from our experience we have seen the following timelines:
Private Payors—90-120 business days
Government Payors—120-180 business days
Facilities—120-160 business days
CREDENTIALING
Contract signed
Customer signs, 3DS starts onboarding process
Discovery Call
Call insurances to verify applications are still open : 3-5 days
Document Request
Gather all relevant documents and information from customer
Application Submission
3DS to submit all applications: within 2 weeks of a signed contract
Follow-up
Follow up with insurance providers & provide customer with biweekly updates
Payer Approval
Application approved; contract & fee list ready for customer
Credentialing serves as a critical mechanism for guaranteeing that patients receive optimal healthcare services by confirming the qualifications and credentials of healthcare providers.
Credentialing is critical in enabling healthcare providers to adhere to regulatory requirements by ensuring that all providers meet the prescribed standards for delivering exceptional patient care.
By exhibiting a steadfast dedication to upholding standards of excellence and safety, credentialing can elevate the standing of healthcare providers, bolstering their reputation and engendering confidence and reliance among patients and the wider community.
Through the rigorous evaluation and verification of healthcare providers’ ability to meet the requisite standards of patient care, credentialing can bolster their fiscal performance by mitigating the likelihood of malpractice lawsuits and heightening patient contentment.
Credentialing plays a pivotal role in facilitating the formation of provider networks, as it entails meticulous validation of the qualifications and credentials of healthcare providers. This, in turn, fosters greater consistency in patient care and enables healthcare providers to furnish patients with more comprehensive and seamless services.
Credentialing Application Processing Time
24 hours
Provider Enrollment Time
60-80 Days
Submitted application to payor Accuracy Rate
98%
Credentialing Application Accuracy Rate
98%
Provider Data Accuracy Rate
More than 95%
Provider Satisfaction Score
More than 97%
Revenue Cycle Management (RCM) refers to the process of managing a healthcare provider’s financial transactions, from patient registration to final payment. It involves optimizing the entire revenue cycle to improve cash flow, reduce medical billing errors, enhance clean claims rate and ensure compliance with regulations.
The RCM process includes patient registration, eligibility verification, charge capture, medical coding, billing, claims submissions and collections. It is a complex process that requires collaboration between clinical and administrative staff.
Effective Revenue Cycle Management can help accelerate revenue, reduce costs, and improve patient satisfaction. It is also essential for maintaining compliance with government regulations, such as HIPAA and the Affordable Care Act.
Medical billing is the process of generating and submitting healthcare claims to insurance companies or other payers to receive payment for services provided to patients.
This involves translating healthcare services into standardized codes, submitting claims, and following up to ensure timely and accurate payment.
Effective medical billing is essential for the financial health of healthcare providers and allows them to continue providing quality care.
Denial management is the process of identifying and addressing denied healthcare claims.
Denials can occur due to incorrect coding, missing documentation, or delays. The goal is to resolve issues and recover revenue through corrections or appeals.
Effective denial management improves financial stability by reducing losses and increasing claim success rates.
Pre-authorization is a process where insurance companies determine if a medical service, procedure, or medication is covered before it is provided.
It ensures that services are medically necessary and meet coverage criteria.
A medical coder is a professional who assigns codes (ICD-10, CPT) to diagnoses and procedures.
These codes are used for billing, insurance claims, and record keeping.
Prior authorizations can take from a few days to several weeks depending on complexity and insurance provider.
Submitting complete documentation helps speed up the process.
ICD-10 is a standardized system used to code diseases, symptoms, and procedures.
It helps ensure accurate billing and documentation.
Outsourcing provides:
