Credentialing, Contracting and contract negotiation/re-negotiation Services :
Provider credentialing and enrollment services are the processes of contracting and attestation that a physician is a member of a Payer’s network and is permitted to provide the services to patients enrolled in the Payer’s plans. Credentialing ensures that a physician fulfills the Payer’s criteria by assessing the individual’s license, experience, accreditation, schooling & graduations, training, partnerships, malpractice, adverse clinical events, and clinical expertise.
Why is Credentialing Required?
Effective provider credentialing services are essential for better practice profitability. Even if the physician is qualified and medically required, insurance companies may delay or refuse reimbursement if appropriate onboarding is not accomplished.
IMBS offers Credentialing services to help providers to boost their revenue. Our specialized provider credentialing services make the payer enrollment process easier for physicians like :
- Formation of new practice.
- Change from one practice to another.
- New provider contracts and group credentialing.
- Looking to enroll with new payers.
- The addition of a new physician or APPs to an established group.
- Create Individual and group NPI for new provider after medical school.
Physician Credentialing Process Flow
Collection
Collect all required data from physicians for filing the credentialing applications
Strategise
Develop an appropriate credentialing strategy by selecting the top payers to which the physician practice send claims
Audit
Audit the application for accuracy & completeness - then file the application
Submission
Submit the filled-up credentialing forms to the insurance carriers either chosen by the physicians or recommended by IMBS
Follow-up
Follow-up with the insurance carriers on a regular basis to track the status of the application
Report
Obtain the enrollment number from insurance carriers and communicate to the physicians
