Physician Medical Credentialing Services
Credentialing is a complex process that involves extensive documentation and verification to join an insurance network. A small error or missing form can delay enrollment and lead to significant revenue loss by making patients from that network inaccessible.
HIGHVIEW BILLING is a leading provider of medical credentialing services in the US. We simplify the process, allowing you to focus on your core mission. Our experts manage credentialing tasks efficiently, from primary source verification to enrollment in premium networks.
MCR DMEPOS Enrollment
Medicare requires Highview Billing's MCR DMEPOS enrollment process to allow you to provide specific products and services, such as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, and bill Medicare for them. Our credentialing services help you enroll in the Medicare DMEPOS program, enabling you to improve care quality and receive Medicare reimbursement.
Commercial Insurance Credentialing
Credentialing with commercial insurance payers can be time-consuming due to varying eligibility criteria and plan complexities. This process may take several months before you can start seeing patients. We ensure there are no delays caused by missing information by gathering and organizing all necessary documentation, including licenses, certifications, and training records. We help you get credentialed with payers like Humana, Cigna, and Aetna.
Revalidation & Re-Credentialing
Revalidation and re-credentialing are needed to maintain compliance and active status with payers. Revalidation typically occurs every five years, and re-credentialing every three years. Our services ensure a smooth revalidation process with Medicare, Medicaid, and commercial insurers. We proactively update your practice information to prevent delays or penalties.
Our Services
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Medicare and Medicaid Provider Enrollment
We help healthcare providers enroll in Medicaid and Medicare, the largest insurance programs in the United States. This opens up access to a broader patient base and can lead to increased revenue for their practices.
NPI Registration (Type 1 and Type 2)
Our healthcare credentialing services assist individual providers (Type 1) and organizations (Type 2) in obtaining or updating their National Provider Identifier (NPI). This simplifies the process of sending HIPAA-compliant bills and claims electronically.
Hospital Privileges
We assist healthcare providers in obtaining hospital privileges, which allow them to admit and treat patients at affiliated hospitals. This enables them to collaborate with other healthcare professionals and expand their scope of practice.
Contract Negotiation
Negotiating with each insurance payer is essential to secure the best terms and maximum reimbursement rates. Our experienced credentialing team helps physicians negotiate contracts with insurers to secure favorable terms for their services, payment rates, and network inclusion.
Reimbursement Issues Audit
We conduct detailed audits of reimbursement processes to identify and address issues affecting your revenue cycle, including insurance payer claim denials, underpayments, delays, and errors. Our goal is to optimize your reimbursement rate and minimize potential revenue losses.
Our Credentialing Process
Contact us
Onboarding
Contact highview-billing 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