CREDENTIALING
Provider Credentialing & Contracting
Payors we work with
FOR INSURANCE NETWORKS
We provide end-to-end credentialing services
Network Research
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.
Application Filing
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.
Application Follow-Up
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.
Appeals for Closed Panels
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.
Out of Network Enrollments
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.
Demographic Changes
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.
Annual Credentialing Maintenance
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.
PECOS and CAQH Set Up and Maintenance
We maintain and manage any PECOS and CAQH profiles that you may use, making sure all information is HIPAA-compliant and accurately profiled.
CREDENTIALING
What we’ll do for your team
Onboarding
Payer Discovery & Application filing & Submission
Contracting / Fees Schedule / Final Approval
Payer Follow-up on Application
Re-credentialing
Why is credentialing important?
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.
YOU SUPPLY THE INFORMATION, WE DO THE WORK
Insurance Contracting and Credentialing
With our insurance contracting and credentialing service, we help your organization establish contracts with the various insurance companies.
Medical Credentialing
Insurance Contracting
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CREDENTIALING
How long does the process take?
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
We’re a metric-driven company.
We’ll provide the following reports, as needed.
Monthly Reports
Provider Enrollment Reports
Provider Credentialing Audit Reports
Credentialing Status Reports
Expiring Credential Reports
Re-Credentialing Reports
We want to see you succeed.
Up-to-date on all HIPPA compliance.
Risk Mitigation
Quality Assurance
Trust and Confidence
Data Security
Competitive Advantage
Custom Support and Communication
We use in-house software
or any software our customers need us to work on
CREDENTIALING
How our timeline will look together
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
Features & Benefits
Improved Quality of Care
Credentialing serves as a critical mechanism for guaranteeing that patients receive optimal healthcare services by confirming the qualifications and credentials of healthcare providers.
Compliance with Regulations
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.
Improved Reputation
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.
Better Financial Performance
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.
Facilitation of Provider Networks
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.
We have high standards for our customers.
Credentialing Application Processing Time
24 hours
Credentialing Application Accuracy Rate
98%
Provider Enrollment Time
60-80 Days
Provider Data Accuracy Rate
More than 95%
Submitted application to payor Accuracy Rate
98%
Provider Satisfaction Score
More than 97%
FAQs
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Provider credentialing is the process by which healthcare providers join with insurance networks or payers. It is necessary because it enables providers to get paid for the services, they render to patients who are insured by certain payers or networks. Providers could not bill for their services and would not be paid without credentialing.
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Partnering with 3DS Healthcare for Provider Credentialing has several advantages, including time and resource savings, reduced administrative burden, accurate and fast credentialing, and increased chances of credentialing success.
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• Initial Provider Credentialing (for New Providers)
• Re-credentialing & Re-validation
• Demographic changes
• Maintenance CAQH/NPPES/PECOS
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Depending on the payer and the physician’s area of expertise, several documents are needed for provider credentialing. In most cases, providers require copies of their professional licenses, malpractice insurance, NPI (National Provider Identifier), and other supporting records.
Providers can get a lot of assistance from 3DS Healthcare in getting ready for the credentialing procedure.
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The duration of the provider credentialing process varies based on the provider’ss specialty, region, and payer they are enrolling with. Usually, the procedure takes a few weeks to several months to finish. This could typically take 60 to 120 days, and if the payers are behind schedule, it might take longer.
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We try to prevent this from taking place. But, if this occurs because of unanticipated events, we stay connected with the payer on a frequent basis to give you up-to-date information and to attempt to speed up the processing. Our team works carefully to ensure we achieve the finest result possible, no matter how long it takes.
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3DS can assist providers in identifying alternative options for credentialing, such as joining other insurance networks or participating in government programs, or helping the providers enrolled as out-of-network providers.
What our customers say
