Doc Assist Me Provider Credentialing Service

Credentialing is the process of verifying a provider’s qualifications to ensure that they can provide care to patients. Most health insurance companies require this process including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.

The providers credentialing process is completed by verifying all of a provider’s documents to ensure that they are valid and current. These include their medical license, malpractice insurance, and DEA.
Additional information necessary to complete credentialing:

• Medical School information
• Internship/Residency/Fellowship’s Information
• Board Certifications
• Provider’s CV

Doc Assist Me Credentialing services, we can assist you with provider enrollment and becoming an in-network provider so that you can receive reimbursements from each carrier. While just a few years ago healthcare professionals considered medical credentialing service “optional” for building a practice, today it has become more necessary than ever for providers to be in-network with insurance companies. Learn how Doc Assist Me can help you get the proper credentials to open a medical practice.

The credentialing team delivers a knowledgeable and comprehensive service to assist you in becoming an in-network provider with the insurance carriers that you want to participate with. We can give you recommendations by performing analysis for your specialty and service area if you need guidance.

We also provide services to existing practices. Credentialing physicians is an ongoing process and must be redone every 3 to 5 years. Doc Assist Me offers a service that will complete re-credentialing, notify you of expiring documents and maintain your CAQH profile.

When you have gathered your documentation and are ready to get started, contact us. We work with practices both large and small, including solo practitioners as well as large 30+ provider practices as well as 1 and 2 provider practices for both Medicare, Medicaid, and Commercial Payers for a group and individual enrollment. Our team has extensive knowledge and expertise for multiple specialties and services, including DME.

Medical Provider Credentialing Process

• The medical provider credentialing process requires involvement from the healthcare provider, the organization, and the payer.
• The organization typically provides the healthcare professional with the credentialing application(s). He or she is responsible for completing the application – which may be many, many pages long – and attaching all requested documentation like board certification, college degrees, and more. When the application is complete, the provider submits it to the organization he or she plans to provide services under.
• The organization is then responsible for attaching additional documentation: any claims history, background screen results, primary source verification, and more.
• Once they’ve completed any healthcare facility portions of the application and attached appropriate documentation, they submit the completed application and supporting documentation to the payer.
• The payer reviews the application to determine whether the healthcare provider meets the payer’s standards. Things they’ll take into consideration include the provider’s education (and accreditation of that program), residency or fellowship, recommendations, malpractice claims history, license, and more.
• This entire process is required when the provider first joins a new practice and then periodically thereafter – usually every two to three years depending on the payer.

What Information is Required for Credentialing?

Information is dependent on payers but tends to be relatively consistent across the board and typically includes:

• malpractice claims history (suspensions, revocations)
• license to practice and primary source verification
• NPI number
• license history
• DEA license
• work history
• degrees and transcripts
• references from previous employers/practitioners
• insurance information
• board certification

Credentialing Your New Medical Practice?

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Outsourcing Credentialing and Re-Credentialing

When you elect to handle credentialing physicians in-house, you must assign resources to compile and send out application materials to new providers; track the completion and collect the documents; complete the facility portion of the application and credentialing process (like primary source verification, malpractice claims review, etc.); send the applications to payers; and then respond to any requests for corrections or additional information from payers. Additionally, that person (or team) must track re-credentialing deadlines and initiate, track, and complete the process every time a provider is due for re-credentialing.

Most importantly, they must develop and maintain expertise in the provider credentialing process, including staying abreast of changes in the industry, credentialing trends, and payer requirements.

Lack of expertise among the credentialing team can lead to denied applications or requests for more information from payers, which can extend the time from offer to start for a new provider – and delay delivering services to patients who need them. For this reason, many healthcare organizations choose to outsource credentialing services for physicians to an expert third-party vendor. Doc Assist Me is one of these vendors.

As experts in medical provider credentialing, we take on the credentialing process from start to finish. That means that all of the responsibilities that would typically fall on the facility can be completed by the team at Doc Assist Me, freeing up your team for more important work. We work with the provider to get the initial application completed, perform the due diligence tasks required of the organization like primary source verification and background screening, and coordinate with payers to support timely approval and expedite provider starts.

Why Choose a Credentialing Service?

Clients often share that they can’t afford to outsource credentialing physicians, but after a review of the expense of managing the medical provider credentialing process in-house, find that outsourcing provides savings for the organization.

When you outsource your medical provider credentialing to a team of experts, efforts can be consolidated; where your team might be credentialing one or two (or twenty) providers at a time, our team is credentialing dozens of providers at once, every single day. This allows us to consolidate steps and save time and money in the process.

Reason to Choose Doc Assist Me Credentialing