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Provider Enrollment & Credentialing

Whether you have a new physician joining the group or an established physician who has been with your practice for years, insurance companies require updating credentials on a regular basis. If updates are not addressed in a timely manner, claims can be denied, resulting in an interruption of cash flow.

Challenge | Services | Approach | Benefits

Challenge

Professionals responsible for the provider enrollment and credentialing processes know the tremendous amount of time, organization, and detail these tasks demand. If applications are not updated consistently and monitored, the organization can run into serious reimbursement issues. Depending on the number of physicians in your group, keeping up with all the provider credentialing requirements and paperwork can be overwhelming.

Our Services

Revenue Cycle Solutions’ Physician Services team features a unique blend of talented professionals who are experienced in the credentialing profession. We understand credentialing is a continuous, tedious process, and we customize our services based on your organizational needs. Some of our credentialing services include:

  • New provider enrollment (All Payers/Multiple States)
  • Commercial insurance credentialing (Aetna, Anthem, BCBS, Cigna, Tricare, Humana, United Healthcare, and others)
  • Medicare and Medicaid Provider Enrollment (including HMOs)
  • Recredentialing for established providers
  • PECOS/Identity and Access Management System updates
  • Professional license renewal
  • Preview (formerly CAQH) enrollment updates and new registration
  • Credentialing and enrollment for physicians assistants, nurse practitioners, and dental providers
  • Demographic or name changes
  • Group and individual Medicare revalidation
  • NPI Registration (Type I and Type II)
  • Facility privileging
  • Payer update requests for changes in demographic/provider information
  • Working closely with insurance payers in all 50 states

Our Approach

Management is often unaware that provider credentials have not been updated or have expired with a particular payer.  RCS consultants use a standardized set of verification guidelines with each new client to make sure all provider credentials are accurately verified. In addition, RCS will:

  • Contact each insurance plan to verify the provider’s effective dates
  • Create and maintain a database of all provider credentials
  • Work with designated personnel at your practice to facilitate the credentialing/provider enrollment process
  • Provide regular updates to your management team
  • Maintain strict confidentiality on provider information

Benefits

RCS’ experienced team provides a cost-effective solution to your practice’s credentialing needs. By working with RCS, your practice:

  • Improves Cash Flow
  • Reduces operating costs of up to 30–40% or more
  • Eliminates clerical errors that delay the enrollment process
  • Reduces training costs due to staff turnover
  • Accelerates revenue by allowing physicians to see patients with certain payers more quickly
  • Improves turnaround time, usually within 60 days
  • Frees up time formerly spent making calls, submitting applications, and handling emails and faxes
  • Allows staff to focus on other important issues, such as Accounts Receivable, Charge Entry, Appointments, Patient
  • Registration, Insurance Verification, etc.
  • Keeps the organization compliant with insurance payers

Please contact us for additional information.