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Credentialing & Enrollment

Let us take care of the paperwork.

Timely credentialing has a direct impact on your revenue cycle and the financial success of your practice. Before a physician or midlevel is able to bill as a participating provider, they must first be contracted with the insurance carrier. This contracting is referred to as entering into a participating agreement with the carrier and dictates the terms and conditions for remaining an “in-network” provider, as well as the payment rate for all contracted services.

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Eliminate Delays & Errors

The process of enrolling with health plans has become increasingly complex and can be both time-consuming and labor intensive to manage at the practice level.  The first step entails verifying and assessing a provider’s qualifications, including education, licensure and training, Curriculum Vitae (CV), and past malpractice history among other important considerations. 

Once the provider is approved by the carrier’s credentialing committee, the provider must then be enrolled with the health plan.  This involves sharing demographic information for the practice, group and individual National Provider Identifier (NPI) numbers, along with practice locations.

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Early notification of an incomplete application or error requires quick action. Our skilled staff will work to resolve these issues and ensure you maintain consistent cash flow.

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Let’s discuss how we can help you achieve the financial goals for your practice.

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Timely & Accurate

The workload associated with this process can be considerable, as individual providers may need to be credentialed with 15 or more payers.  Typically, each payer has different requirements and renewal schedules.  Any delays or errors in this process can lead to an increase in claim denials, ultimately slowing the reimbursement process and resulting in lost revenue for the practice.

 Practicefirst helps facilitate hassle-free credentialing and enrollment by managing the entire process for you.  Our electronic system will track application progress, identify errors, and provide alerts of credentialing items that require attention. Early notification of inaccurate information allows us to resolve potential issues as quickly as possible and avoid any disruption to your practice operations or cash flow.

Our skilled experts are adept at navigating the challenges.  We streamline the process by:

  • Monitoring deadlines to ensure credentialing applications are submitted timely.
  • Managing CAQH enrollment - New applications, application updates, and quarterly attestations.
  • Managing payor enrollment with commercial and governmental health plans.
  • Providing automated oversight of “credentialing expirables” - Medical licensure, DEA registration, CAQH provider profiles, and malpractice insurance.
  • Continuous monitoring of state and federal exclusion lists, as well as license suspensions.
  • Facilitating NPI registration and PECOS setup/maintenance.
  • Processing initial applications and revalidations of government payers.

You Have Financial Goals.
We Help You Achieve Them.

Talk to us about meeting your practice’s financial goals with end-to-end RCM solutions.

Contact Practicefirst

Let’s discuss how we can help you achieve the financial goals for your practice.

Don't just take our word for it.

"We have been with Practicefirst for complete Revenue Cycle Services since our Hospitalist group was formed in January 2014 and have experienced excellent support and service while allowing us to grow and achieve our patient focused mission."

John Patti, M.D.
Infinity Medical of WNY, PC

"Practicefirst has been handling our Medical Billing and A/R follow up since January 2011. They have provided above average financial results with excellent customer service affording us the opportunity to focus on our most important goal, patient health!"

Debbie Chapman, Practice Manager
Pediatric Cardiology of WNY, PC

"I’ve used Practicefirst ‘s full-service Practice Management solution since 2005, including medical billing, coding, and documentation training. Monthly documentation and financial reports have been invaluable to our practices."

Greg DiFrancesco, M.D.
University Emergency Medical Services, Inc.

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