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Provider Credentialing and Enrollment Services

Provider Credentialing and Enrollment Services

Provider Credentialing and Enrollment Services

by prgmdinc

Provider Credentialing and Enrollment allow healthcare providers to enroll with insurance payers. In addition, the patients can use their insurance to pay for services physicians render. Similarly, the provider gets payments for the medical services. Therefore, healthcare providers must enroll with payers. Healthcare practices can find loopholes in their claims submissions with our Medical Billing Audit Services. In addition, they should get Provider Credentialing and enrollment with maximum payers.

Our Eligibility Verification Services enable providers to know about the insurance of the patients. Also, it allows patients to utilize their payment plans. Moreover, not doing so may result in patients in search of other providers. As a result, you are going to miss your potential patient.

Physicians/providers must credential themselves, i.e., enroll and attest with the Payer’s network and be authorized to provide services to patients who are members of the Payer’s plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.

Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively. Our customized Payer credentialing and enrollment services support physicians in:

  • Starting or joining a new practice
  • Switching from one physician practice group to another
  • Join or become affiliated to new groups or practices
  • Enroll with new payers
  • Maintain their credentialing services.

CAQH Attestation

Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative processes between health plans and providers for credentialing, directory maintenance, coordination of benefits, and other essential business functions.

  • CAQH application filing
  • CAQH quarterly attestations

   Expirations and Renewals

  • The tracking expiry date for State DEA License, Board certificate, and Malpractice Insurance
  • Tracking and Analytics
  • Maintaining a repository of the provider’s credentialing documents
  • Maintaining Contracting agreements
  • Tracking credentialing dates, expiration, and alerting dates to initiate credentialing processes
  • Working with the denials team to understand if there are any claim denials due to credentialing issues

New Registrations/Renewals of an Individual Provider

  • With the State
  • With the Drug Enforcement Agency (DEA)
  • Provider Data Maintenance – Update Management on Payer Systems
  • Provider demographic update in payers file. (Updates of Provider’s specialty or additional educational qualifications)
  • Provider directory maintenance on payer websites. ( Checking payer website and verifying provider details like Phone and Fax #, Zip code. Updating the correction to payers )
  • EFT/ERA enrollments
  • Contracting Creation and Maintenance

  • New Group/Individual Practitioner contracts
  • Adding / Deleting providers in the existing contract
  • Adding/Deleting location in the current contract
  • Adding / Deleting plan types ( Line of Business ) in the current contract
  • Rate Negotiation


  • Collect all the data and documents required for filing credentialing applications from the physicians
  • Store the documents centrally on our secure document management systems
  • Understand the top payers to which the practice sends claim and initiate contact with the payers
  • Apply the payer-specific formats after a due audit
  • Timely follow-up with the Payer to track application status
  • Obtain the enrollment number from the Payer and communicate the state of the application to the physician
  • Periodic updates of the document library for credentialing purposes

Make Your Practice Great with Us

Provider credentialing and Enrollment firm in USA, PRG takes ownership of the entire Credentialing Process from start to end. Moreover, focus on your core expertise and let PRG handle the credentialing part of your practice. In addition, we help you acquire more payers to provide medical services to a large number of patients. Also, from the initial application of the provider to the coordination with payers, we do it all for you. As a result, we ensure rapid approvals.

Are You Ready to Embrace the Change?

Partner with Physicians Revenue Group Inc. for Credentialing Services. Above all, we have an understanding of all the policies and procedures payers need. In addition, tracking re-credentialing deadlines and completing the entire process every time the provider needs to go for re-credentialing. Moreover, you need to be aware of the latest rules in the credentialing process and payer requirements.

Provider Credentialing Services Benefits

  1. Your data stays up-to-date with the payers
  2. In addition, you get faster reimbursements from payers
  3. As a result, you can get more patient referrals
  4. You can get rid of paperwork and fill out application forms
  5. Similarly, you can minimize Claim Denials with efficient Revenue Cycle Management Services
  6. You get in touch with various payers
  7. Provide you a competitive edge over others in terms of cost-effectiveness.
  8. Get credentialed faster with all significant payers
  9. Reduce claim denials and improve cash flow
  10. Get more patient referrals from the network
  11. Avoid piles of paperwork with our document management system
  12. Get support for filling up cumbersome application forms
  13. Reduce costs of the credentialing process with our global delivery teams
  14. Get timely reports on the status of your application

We will Handle the Paperwork

Many practitioners tend to try and manage a medical provider credentialing process in-house. However, after reviewing the expenses, most have found that outsourcing to PRG is a cost-effective approach.

When you outsource your credentialing to a team of professionals, your efforts can be consolidated; where your staff might be credentialing one or two (or maybe twenty) providers at a time, our team at PRG is capable of credentialing dozens of providers all at once, every day. This not only save you money but valuable time for your staff to focus on more important task, ensuring the growth of your practice.

Let our Credentialing Service to take on the work of provider credentialing and ongoing maintenance. Our experts know all the payers, what they need, and what actions are required to get successfully credentialed. PRG provides monthly updates and complete transparency throughout the payer credentialing process.

Credentialing is a Vital Component

Provider credentialing is a foundational task as practices offering services that cannot be billed is neither feasible or nor sustainable for a medical organization.

The credentialing process ensures that the provider meets the required standards of the medical organization and its payers, as well as identifying the risk factors early on to reduce the risk of any adverse outcomes. Not to mention, credentialing is a great way to improve PR to attract new patients and gain their trust.

Although credentialing is time-consuming, it protects your revenues, limits risk of any potential loss, and enhances your practice’s overall reputation.


Credentialing & Re-Credentialing

At PRG, our team of professionals maintains expertise in the provider credentialing process, including staying abreast of changes in the industry, credentialing trends, and payer requirements. As experts, we take on the credentialing process from start to finish. That means our team takes on all of the responsibilities that typically fall on your staff, freeing up your team to focus on more important tasks.

We track the completion and collect the necessary documents; complete the credentialing process; send applications to payers, and then swiftly respond to all requests for corrections or any additional information from payers. At PRG, we assign a team of experts to track re-credentialing deadlines and initiate and complete the process each time your practice is due for re-credentialing.

Our team works with the provider to fill out the initial application, perform the due tasks required of the organization such as primary source verification, and background screening, and coordinate with payers to support timely approval as well as expedite provider starts.

What PRG Do for Providers

  • Saves your time, so you can focus on core areas
  • Minimizes the use of large amounts of paperwork
  • More patient referrals
  • Getting rapid payments from the Insurance Companies
  • Dedicate resource person for your practice
  • Continuous follow-ups, by making calls, messages, and emails.
  • Get real-time access to online portals


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