Provider Credentialing is the catch-all term that refers to the 3 part process of Credentialing, Enrollment, and Primary Source Verification. Each step of the process represents a time-consuming endeavor for healthcare organizations regardless of their size or expertise.
The importance of provider credentialing can’t be understated because, without accurate and timely completion of this process, providers will not be able to accept payment from government or private insurance companies.
Medical practices, groups, and health systems that leverage Medusind’s Provider Credentialing Service remove the administrative burden of first-time credentialing, enrollment, and primary source verification and the ongoing time-suck of keeping these records up to date across the provider’s contracted payers.
Medusind handles provider credentialing for all carriers including Medicare and Medicaid.
For Medicare credentialing and enrollment, all activity is managed electronically using the CMS PECOS system using delegated responsibility from the provider or healthcare organization.
Medicaid credentialing and enrollment is a separate process from Medicare credentialing and enrollment. As such, activities are executed digitally as state capabilities and regulations allow.
Medusind executes provider credentialing for all commercial carriers like United, Anthem, Aetna, Cigna, Humana, and more.
Practices who use our credentialing service save serious time because they eliminate the burden of managing a separate provider portal for each insurance with which they are contracted.
Medusind manages and executes provider credentialing and enrollment digitally as each commercial carrier’s technology capabilities allow.
Our provider credentialing and enrollment service includes primary source verification to further reduce your organization’s administrative burden.
Arguable the most tedious activity associated with provider credentialing and enrollment, primary source verification is the process of gathering documents certifying education, training, licensure, and more from their original source.
Avoid the hassle of contacting university registrar offices, state boards, and hospital residency programs by utilizing our primary source verification expertise.
Our expert provider credentialing, enrollment, and primary source verification services eliminate the ongoing, time-intensive process of ensuring your providers are able to accept payment from Medicare, Medicaid, and Commercial Insurance Carriers.
Leverage our provider credentialing services to eliminate time spent chasing paperwork and keep revenue flowing to your practice. Connect with us to learn more.
Request a quote or learn more about our Payer Credentialing Services!
Provider credentialing services from Medusind are extremely affordable and competitively priced. There is an a la carte fee based on a per provider rate that also takes into account the number of insurance carriers with which a provider is contracted. Or, based on your organization’s needs, credentialing services can be bundled into a revenue cycle management rate.
No, our provider credentialing service rate is inclusive of primary source verification services.
Healthcare organizations, regardless of size, benefit from the elimination of the administrative burden tied to chasing paperwork, contacting and waiting on 3rd parties to provide documentation, and managing a multitude of carrier portals to keep credentialing and enrollment up to date. Additionally, outsourcing credentialing to Medusind provides the peace of mind that you’ll avoid the fire drill of a last minute enrollment and the revenue crunch of a missed re-enrollment.
The only correct answer is ultimately “it depends.” Work begins immediately on the Medusind side but the overall length of time from submission to acceptance is based on the speed with which insurance carriers (including Medicare and Medicaid) handle their end of the process. This fact makes it important to stay on top of deadlines and to leverage the expertise of a revenue cycle organization like Medusind.
Often the terms are used interchangeably but technically there is a difference. Provider credentialing refers to the process of verifying the education, training, licensing, and more of an individual provider. (This is closely linked to primary source verification.)
Provider enrollment is the process of providing these credentials to an insurance carrier so that they may make a decision to accept the provider into their network and ultimately provide payment to them.
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