Enrollment & Physician Credentialing Services
We Provide:
Credentialing & Provider Enrollment Maintenance Service
Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle.
CAQH Setup, Maintenance and Attestation
The healthcare industry’s premier resource for self-reporting professional and practice information to health plans and other healthcare organizations.
NPPES Registration
The NPI (National Provider Identifier) Registry enables you to search for providers in the NPPES (National Plan and Provider Enumeration System) system. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice
Address Updates
Practice information is used in claims processing. Keeping your information up to date helps ensure that patients can locate your practice and your claims process accurately.
Maintenance of Provider Qualifications
(DEA, License, Malpractice, etc.)
Hospital Credentialing and Recredentialing Applications
Develop credentialing standards for identifying competent physicians and healthcare professionals who are eligible to participate in the Network.
Recredentialing and Maintenance Services with Commercial Payers
Medicare & Medicaid Re-enrollment
FAQ’S
What are the advantages of getting credentialed?
After a healthcare provider has been credentialed, they become part of a health insurance network. As participants, they have agreed to accept the payment fees and by becoming a provider, a practitioner becomes accessible to more patients.
How much does it cost?
Our credentialing service is affordable for the level of service and technology that you receive. Each proposal is designed based on the needs of the organization. For more information, please contact us at (609) 972-5481
How long does it take a practitioner’s application to go through the credentialing process?
It might take 60-120 business days from submission of initial application to the approval stage. Having your licensure and all qualifications in order helps speed up the process. We send a checklist of all the documents that are required so that we can begin. Once they are received, we upload your data into our system and work to get your applications completed and submitted to insurance companies. We then follow up regularly with insurance companies to make sure that your credentialing applications are received and being processed and approved without unnecessary delays.
Can a physician or other practitioner work before completing the credentialing process?
No.
Which Payers should My Practice Participate In?
Each Healthcare provider has different needs. Our team begins by reviewing your specific network needs or evaluating of the top payers in your area.
How do I get status of my credentialing?
When working with our medical credentialing team, you will know the status of your applications every step of the way. You will receive status reports on all your credentialing projects and You can also call our office anytime and speak with one of our specialists to get an update on your medical credentialing.
Do you offer any service to keep up the documents and insurance contracts that expire and must be renewed?
Yes, 30, 60, and 90 day prior notifications of any expired licenses including: DEA, State licenses, Board Certification and more. 90 and 120 day prior notification of any upcoming hospital or facility re-credentialing needs.
About us
What is credentialing and how it works:
Credentialing is a process by which insurance networks and healthcare organizations obtain and evaluate documentation regarding a medical provider’s education, training, work history, licensure, regulatory compliance record, and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility.
Credentialing is a vital process for all healthcare institutions that must be performed to ensure that those healthcare workers who will be providing the clinical services are qualified to do so.
What we do:
Whether you’re a multi-specialty group or a solo practitioner, our experienced team of credentialing experts can take your organization through the entire credentialing process and recredentialing our credentialing services and enrollment related services you or your practice might need.
At CM& D Credentialing LLC, we understand each practice has their own needs to address. Our Credentialing specialists maintain a high degree of discretion and trustworthiness in the handling of confidential information associated with the credentialing process.
