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Credentialing

Credentialing

credentialing and enrollment

Master the Differences Between Provider Enrollment & Credentialing

Interchanging the terms credentialing and enrollment is a surefire way for your provider reimbursement to take a serious hit. The problem is that there is definitely overlap between them. Ultimately, however, having a solid understanding of each process and knowing the differences between provider enrollment and  credentialing is the only way to more efficiently and […]
Published Date: April 6, 2021
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CAQH ProView Portal

CAQH ProView Portal: Make Credentialing/Enrollment Faster & Easier

Your patients pay for their health insurance and want to use it. This means that if you want to treat them, you need to be enrolled in their health insurance plan. Participating in insurance networks almost certainly guarantees you will be required to utilize the Council for Affordable Quality Healthcare (CAQH) ProView Portal, and it […]
Published Date: March 31, 2021
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CAQH Profile

Comply with 2021 CAQH ProView Changes & Avoid Payment Delays

Keeping your provider credentialing up to date is critical to your practice’s financial success, and your CAQH profile is a big piece to that puzzle. 2021 is bringing significant updates to CAQH ProView that you can’t afford to miss. It’s imperative that you get a handle on these changes now otherwise you’ll feel it in […]
Published Date: February 24, 2021
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CAQH credentialing process

CAQH Updates: Ace New Features and Speed Credentialing Process

QUESTION: I credential our providers via the online CAQH portal and I am confused by some of the recent updates. Specifically, the taxonomy code set change and the new NUCC grouping. Does CAQH now follow the NUCC code set? What other changes are new?  CAQH credentialing process. Parsippany, NJ subscriber ANSWER: The CAQH updates bring […]
Published Date: August 6, 2020
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Physician Credentialing: Prevent Cash Flow Break with NPI Accuracy Essentials

Make no mistake! Setting up and maintaining the accuracy of each of your physician’s National Provider Identifier (NPI) is essential and COMPLEX. Any error on your NPI application will result in your reimbursement being delayed and a hit to your practice’s cash flow. As a Medicaid/​Medicare provider, you are required to obtain a NPI to […]
Published Date: June 23, 2020
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Credentialing Hospital Privileging

Speed Up Doctor’s Hospital Privileging

QUESTION: Our providers have privileges at two separate hospitals. Every couple of years, they make us jump through a variety of hoops to keep our providers’ hospital privileges active. This year, one of the hospitals is asking us to send provider references. Who should we ask? Anonymous, Alpharetta, GA ANSWER: Hospitals typically ask for three […]
Published Date: December 26, 2019
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Credentialing tools

Credentialing Tools: Checklists and Programs to Speed Applications

Your provider cash flow will come to a screeching halt unless you secure on-time insurance enrollment and hospital privileges. But with so many steps and forms to keep up-to-date, avoiding an accidental lapse in credentials can be really easy. With the right tools, you can stay on top of the process and your reimbursements flowing. […]
Published Date: September 19, 2019
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provider credentialing

New Provider Credentialing: Your Top 10 Questions — Answered!

Does even thinking about new provider credentialing give you a headache? Sure, you’re anxious for new providers to start generating revenue for your practice. But you’re also dreading those long, complicated forms that are so easy to mess up. Credentialing is anything but simple. One misstep, and your practice’s revenue cycle will slow to a […]
Published Date: August 15, 2019
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Medical Credentialing: What Is It & Why Is It Important for Reimbursement?

Without proper medical credentialing, a medical practitioner legally cannot work at a hospital or partner with insurers. Having medical staff credentialing training is crucial to ensure staff properly attain and maintain physicians credentials. Only a new physician or practitioner who is credentialed is allowed to see patients, receive insurance reimbursements, and treat hospital inpatients. Fail […]
Published Date: July 25, 2019
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