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Credentialing and Enrollment Services

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SMD Provider Enrollment and Credentialing Services

 

Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.  Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in your practice – failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers and following up with them to close the credentialing request. Trust Access Healthcare to get you credentialed fasters as we understand the forms required by each payer, and their policies and procedures.

PROVIDER CREDENTIALING

The process involves the following steps:

  • Application Evaluation. Completing required documentation and identifying exceptions.
  • Primary Source Documentation. Verify practitioner/ facility information from physicians.
  • Outbound Call Center. Obtain missing documents and updating payer’s database.
  • Follow-up with payers. Follow-up on submitted credentialing requests.
  • Data Entry. Capture data, label and link images to specific providers/ facilities in payer’s database.
  • Maintenance of Provider Data. Update provider information as per policies and procedures, and CAHQ profile.

 

PROVIDER ENROLLMENT

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:

  • Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims
  • Updating practice’s Pay-to address. Validate and update the provider’s pay-to address or the billing address
  • Enrolling for electronic transactions. Our team can enroll providers for four types of electronic transactions:
    • Electronic Data Interchange (EDI)
    • Electronic Remittance Advice (ERA)
    • Electronic Fund Transfer (EFT) and
    • CSI
  • Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

New Provider Enrolment

This is one of the most challenging tasks and may be cumbersome. Knack Global is extensively experienced in enrolling with various insurance carriers across all 50 states. This had made us capable of handling more varied application processes and dealing with it effectively.

  • We prepare and format the applications and send across for signature
  • We submit and track each application
  • We complete the enrollment applications
  • We verify with the insurance carrier for the specialty of the provider
  • We continually track and address issues related to reimbursements and contracts
  • We offer full enrollment services for a wide array of insurance companies
  • We offer higher accuracy and pace in the system
  • We compile the PINS and process it to the providers with quickly

State Licensure Registrations

You require an active license for any medical practice. We ensure that your license is active and does not hamper your business continuity

Credentialing Review

We source data from the providers and verify it. We check it thoroughly and authenticate the validity of the information submitted.

Application Submission

We custom fit the applications and understand the prerequisites. We ensure applications are submitted with complete information in a timely manner

Who can use Knack Global Enrollment and Credentialing Services:

  • Solo practitioners
  • Small to large multi-state/national groups
  • Outpatient clinics
  • Hospitals
  • Telehealth companies
  • Radiology centers
  • Imaging centers
  • Sleep labs
  • Behavioral health clinics
  • Dental clinics
  • Chiropractic offices
  • Nursing homes
  • DMEs
  • Labs
  • Urgent Care Centers
  • Ambulatory Surgical Centers

Document Maintenance

We have leading-edge web applications that maintain your database for handy use. It is available for verification at any time and it is secured. Knack Global keeps you free from the worry of losing data or misuse of any information. We maintain a comprehensive list of documents like license, DEA/CDS, provider certificates, liability insurance, training documents, bank letters and everything you require for information management.

Our web application has a database of the provider information that can be verified at any point in time. Providers and hospitals can feel secured against loss of data. We offer a range of services in a hassle-free manner and keep a record of all documents.

Document Expiry Tracking

All documents in the healthcare industry need timely renewal. Providers and even healthcare units often miss the on-time renewals. We keep a weekly track of each document and notify the client in advance.

The following types of information are subjected to expiration:

  • Healthcare licenses
  • Professional liability insurance
  • Drug Enforcement Agency (DEA) or Controlled Substance certificates
  • Board certifications.
  • Other certifications as required by the Payors.

Knack Global assures prompt and responsive services for the enrollment and credentialing processes. Our team is expert in handling a multitude of specialties and provider enrollment and can deliver it with better results. We have a transparent process and the client can access all reports on a real-time basis. We ensure quality compliance and round the clock assistance.