Medical Credentialing

It was only a couple decades ago that healthcare professionals considered medical credentialing—that is, the process of getting enrolled in an insurance company’s preferred provider network—to be an optional step in building their medical practices, or an unnecessary step to growing their client/patient caseloads.

Back then patients did not expect every healthcare provider to accept their insurance (some corners of the healthcare industry, like mental health services, weren’t even covered by most insurance plans). Also, many patients had “out of network benefits,” which meant that the patient could meet with a doctor of his/her choice and then file for reimbursement from his/her insurance company later. Oh How Things Have Changed.

Today, it is more necessary than ever for physicians and healthcare providers to be in network (AKA: “credentialed”) with insurance companies. This is a necessity, in part, because more people in the United States have health insurance than ever before. And it is a necessity because people today demand that their healthcare providers accept their insurance. Put bluntly, if you are not in network with a potential patient’s health insurance plan, you’re at risk of losing that potential patient to a competing practice.

Rid yourself of all the headaches, mounds of paperwork, and confusion with the insurance companies! Trust the experts at Revenue Management Corporation to help you navigate the difficult process of provider enrollment and medical credentialing all at a low cost. 

 
 
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Who We work with

  • Physicians 
  • PAs/NPs
  • Hospitals
  • PT/OT/SLP
  • Podiatrists (DPM)
  • Ambulatory Surgery Centers (ASC)
  • Urgent Care Facilities 
  • Clinical Laboratories 
  • Diagnostic Testing Facilities (IDTF)
  • Sleep Labs
  • Optometrists
  • Audiologists 
  • Behavioral Health Providers
  • Many More
 

Credentialing Services

  • Commercial Insurance Provider Enrollment and Credentialing (Example: Aetna, Anthem, BCBS, CIGNA, Tri-Care, Humana, United Healthcare, and many more. 
  • Medicare and Medicaid Provider Enrollment & Credentialing 
  • Medicare and Medicaid Revalidation
  • PECOS
  • CAQH Registration
  • NPI Registration (Type I & Type II)
  • Reimbursement Issues 
  • Managed Care Contracting Issues
  • Hospital Privileging
 
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Why Use Us?

  • We'll save you on average at least 2 months of time and over 100 or more hours of work.
  • Take away all the headaches due to the mounds of paperwork and endless applications. 
  • Increased patient referrals. 
  • Collect payments from insurance companies faster. 
  • Contracts and applications setup correctly the first time. We will not stop until the process is 100% complete. 
  • Dedicated project manager. 
  • We make all the phone calls, follow-ups, and submit all applications, e-mails and faxes for you. 
  •  24/ 7 access to documents related to your project!
  • The service is typically provided at a cost less than it would be for you to hire your own provider enrollment or credentialing team and we can handle any volume you have! 
 

What You Get: 

  • An “All Purpose” credentialing manager to represent you with commercial and government payors.
  • We complete all applications and necessary paperwork on your behalf with the chosen payor networks and government entities.
  • Status reports so you know where you are in the process with each payor.
  • Maintain and update CAQH profile.
  • Complete all necessary credentialing requirements for each payor and follow through to completion.
  • Follow all payor contracts through to contract load date and provide copy of fully executed contract and fee schedules to your practice or billing company.

 

We handle the entire enrollment and physician credentialing process from start to finish for one low flat fee!