Physician Medical Credentialing Services
Credentialing is a complex process that requires a lot of documentation and verification to become part of an insurance network. A simple error or missing form can delay enrollment and result in a significant loss of revenue by making that network’s patients inaccessible to you.
Medcare MSO stands out as the premier provider of medical credentialing services in the US. We simplify the process so that you can focus on your core mission. Our experts handle credentialing tasks efficiently, from primary source verification to premium network enrollment.
MCR DMEPOS Enrollment
Highview-billing Carrier Request, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (MCR DMEPOS) enrollment is the process required by Medicare to be allowed to provide these specific products and services and bill Medicare for them. Our credentialing services help you enroll in the Medicare DMEPOS program, so that you can improve the quality of care and receive reimbursement from Medicare.
Commercial Insurance Credentialing
The credentialing process with commercial insurance payers can be lengthy due to varying eligibility criteria and plan complexities. The process can take several months before you can start seeing their patients, so we make sure there are no additional delays due to missing information. Our expert team gathers and organizes all required documentation, including licenses, certifications, and training records. We ensure you get credentialed with commercial insurance payers like Humana, Cigna, and Aetna.
Revalidation & Re-Credentialing
Revalidation and re-credentialing are required over time to ensure continuous compliance and active status with payers. Usually, validation is required every five years, and re-credentialing is required every three years. Our physician credentialing services offer a smooth revalidation process with Medicare, Medicaid, and commercial insurers. We proactively update your demographics (practice location, contact information, etc.) to prevent any delays or penalties.
Our Services
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Medicare and Medicaid Provider Enrollment
We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. This leads to a wider patient base and, potentially, a lot more revenue for their practices.
NPI Registration (Type 1 and Type 2)
Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.
Hospital Privileges
We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice.
Contract Negotiation
Negotiation is required with each insurance payer to get the most favorable terms and maximum reimbursement rates. Our experienced credentialing team helps physicians negotiate contracts with insurers to get the most favorable terms for their services, payment rates, and network inclusion.
Reimbursement Issues Audit
We conduct thorough audits of reimbursement processes to identify and resolve issues that may be affecting your revenue cycle. These issues include claim denials, underpayments, delays, or errors by insurance payers. Our goal is to optimize your reimbursement rate while minimizing potential revenue losses.
Provider State Licenses
We assist providers in obtaining and renewing state medical licenses. The rules and regulations for issuing licenses to healthcare providers differ by state. Obtaining and renewing state licenses can benefit providers in three ways: compliance, competence, and liability protection.
Our Credentialing Process
Onboarding
Contact highview-billing MSO to discuss the details of your organization and health plans for enrollment
Gather Your Documents
We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements
Submit Your Applications
Our team will complete the appropriate applications and submit them to your preferred payers
Verification and Notification
We will verify your credentials with the issuing bodies. Our expert team will double-check everything with the official sources. Once everything is in order, we will assist you in obtaining approval from hospitals and insurance companie