Provider Enrollment and Credentialing Services in healthcare is as fundamental as a physician's license to practice. This essential process, known by various names—medical credentialing, healthcare credentialing, or insurance credentialing—is mandated by authoritative bodies like CMS and the Joint Commission. Insurers require credentialing to add physicians as in-network providers, a status that's essential for eligibility to receive reimbursements.
For a provider, credentialing is an exhaustive process involving every health plan they intend to enroll in, and it can feel like an avalanche of paperwork. Normally, this process might take anywhere from 30 days to 6 months. However, MedQuik Solutions drastically reduces this provider enrollment time frame to between 8-14 days, thanks to our advanced technology and automated software.
Extended credentialing periods can impose a financial strain on practices. We expedite this process, minimizing any potential financial impact. Our technology is designed to prevent delays that can arise from even minor errors, ensuring error-free and swift provider enrollment and credentialing services. Staying abreast of regulations and with persistent follow-ups, MedQuik ensures broad and expedient access to care.
New Graduates : For doctors, nurses, and therapists starting their careers, credentialing is a vital step. It verifies their education, training, and licensure, allowing them to begin practicing with confidence and legitimacy.
Healthcare Transitions : Any provider moving to a new state or facility needs to undergo credentialing. This process ensures they comply with the specific regulations and requirements of their new location or institution.
Private Practice : Dentists and other specialists setting up their own practices must be credentialed to validate their qualifications and establish trust with their patients. This step is crucial for securing affiliations with hospitals and other healthcare entities.
Insurance Updates : Providers joining new health plans need credentialing to expand their patient base. This process ensures they meet the standards of various insurance companies, allowing them to offer services to a broader audience.
Regular Updates : Ongoing re-credentialing is required for all practitioners to maintain their standing and keep up with current standards. This regular process ensures continuous compliance with professional and legal requirements.
Choosing our medical billing and credentialing services ensures unparalleled support and efficiency for healthcare providers. Our dedicated specialists bring a wealth of expertise in handling a wide range of provider types, guaranteeing a smooth and hassle-free credentialing journey. We offer customized support tailored to the unique needs of each provider, whether they are solo practitioners or part of large medical groups.
Our process is meticulously designed to minimize delays in provider enrollment, enabling a quicker start to billing and service delivery. By leveraging our comprehensive support, healthcare providers can effortlessly navigate the complex credentialing landscape, ensuring full compliance with all regulatory requirements. This allows them to focus on what they do best—delivering quality care to their patients.
Our credentialing service is designed to ensure healthcare providers meet industry standards and operate with the utmost efficiency. Here are the key features of our service:
Alignment with Industry Standards :
We align provider qualifications with industry standards from NCQA, URAC, and AAAHC to ensure compliance and quality.
Advanced Digital Tools :
Leveraging the latest digital tools, we compile comprehensive background information efficiently and accurately.
In-depth Verification :
We conduct thorough verification processes to ensure all provider credentials are current and robust.
In-network Facilitation :
Our service facilitates providers in achieving in-network status with insurance companies, ensuring seamless reimbursement processes.
Ongoing Re-credentialing :
We offer ongoing re-credentialing services to maintain compliance with provider network requirements.
Proactive Renewal Management :
We proactively manage license and certification renewals to prevent any service gaps.
Medicare, Medicaid, and Payer Navigation :
We provide comprehensive navigation of Medicare, Medicaid, CAQH, and non-CAQH payer complexities.
Customized Support :
Our service offers customized support tailored to healthcare providers of all practice sizes and specialties.
Efficient Credentialing Timelines :
We significantly surpass the typical industry pace, ensuring quick and efficient credentialing.
Major Payer Coordination :
We determine which insurance companies are the practice's major payers and reach out to them to streamline processes.
We begin with a thorough consultation to understand your specific credentialing requirements, whether you’re a solo practitioner, part of a group practice, or a healthcare facility.
Our team assists in the collection of all necessary documents, including licenses, certifications, and professional references, leveraging our digital platform for ease and efficiency.
Each piece of information is meticulously verified against primary sources. This includes educational background, training, board certifications, work history, and any necessary legal checks.
With all documents verified, we compile and submit your credentialing application to the relevant healthcare plans and facilities, ensuring completeness and accuracy to avoid delays.
MedQuikSolutions acts as an active intermediary between you and the credentialing bodies, handling all follow-up communication to ensure a smooth approval process.
Even after approval, we continuously monitor credentialing status, including renewal dates and compliance requirements, to ensure you remain in good standing with all networks and regulatory bodies.
Credentialing isn’t a one-time event. We provide re-credentialing services to manage and maintain your credentials, keeping them current and compliant with evolving standards and regulations.
Clients receive detailed reports at each step of the process, offering insight into the status of their credential applications and any actions required.
Primary Source Verification (PSV) : Direct verification of qualifications from original sources.
ECFMG Certification : For graduates from medical schools outside the U.S
FCVS Portfolio : A comprehensive record of a physician's core medical credentials.
NPDB Check : Information on malpractice payments and professional conduct.
Board Certification : Verification of specialty expertise.
CME Credits : Confirmation of ongoing education to maintain licensure.
State Licensure : Essential for legal medical practice within a specific state, affirming compliance with state-specific medical standards.
DEA Registration : Authorizes the physician to prescribe controlled substances, ensuring adherence to federal drug policy and regulation.
Licensure Verification : Confirmation of a current, unrestricted nursing license.
Education Verification : Validation of nursing education from accredited programs.
Certification Verification : For nurses with specialized roles or advanced practices.
Clinical Privileges : Specific to APRNs, detailing authorized practice scope.
Background Checks : Comprehensive checks for safety and reliability.
Licensure Verification : Ensures valid licensure for practice in their specialty.
Education and Training : Verification of degrees from accredited programs.
Certification Verification : Validates specialized certifications, if applicable.
NPDB Check : Reviews for malpractice or disciplinary actions.
Professional References : Assesses professional conduct and clinical skills.
Background Checks : Ensures no criminal convictions or sanctions.
We designated a phenomenal HIPAA Compliance manager for applying, administering and assuring all transactions underwent within the criteria of the HIPAA rules and regulations.
Call Us : +1 (631) 417-0212
Mail Us : info@medquiksolutions.com
Address : South Setauket, NY 11720, USA.
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