New Provider Credentialing (Initial Credentialing)
From signed offer letter to billable with every payer that matters, run as one timeline.
At ZechionMed We provide complete Initial Provider Credentialing Services to doctors advanced practice providers behavioral health professionals as well as allied health professionals as well as healthcare organizations throughout all across the United States. Our credentialing experts assist providers to complete their enrollment in commercial insurance providers, Medicare, Medicaid, and healthcare networks, all while ensuring conformity with current industry standards and the requirements of payers.
Our simplified credentialing process eases administrative burden, decreases delays in enrollment, and lets providers see patients in the same way and receiving their reimbursements as soon as they can.
What We Cover
Credentialing Issue Resolution · Benefits
Provider Credentialing Application Preparation
Services include We create complete and accurate credentials for all of the insurance companies that are part of the network.
- Initial provider enrollment applications
- CAQH profile complete
- Medicare enrollment (CMS applications)
- Medicaid enrollment assistance
- Commercial payer enrollment
- Hospital credentialing documentation
- Group practice enrollment
- Individual provider enrollment
- Support for multi-state credentialing
- Quality review of applications prior to submission
Provider Credentialing Application Preparation
Benefits
- Processing of applications faster
- Reduction in rejection rates
- Complete documentation
- Provider information that is accurate
Credentialing Document Collection & Review
Documentation includes Our credentialing team gathers confirms, and arranges the documentation required by providers prior to the submission.
- State medical licenses
- DEA registration
- Controlled chemical licenses
- Board certifications
- Medical school degrees
- Certificates of residency and fellowship
- Verification of the work history
- Curriculum Vitae (CV)
- References from professionals
- Certificates of insurance for malpractice
- Identification from the government or driver's license
- NPI verification
- Documentation for W-9
- IRS documentation
- Practice information
Credentialing Document Collection & Review
Benefits
- Complete credentialing and authorization packets
- Reduced documentation that was missing
- Better acceptance of the payer
- Faster approvals
Provider Profile Creation & Management
Services include We design and enhance profile profiles for providers that are required by the companies that pay for credentialing and also by payers.
- CAQH profile configuration
- CAQH attestation management
- NPPES review of registration
- PECOS profile assistance
- Provider demographic management
- Review of specialties designations
- Practice location management
- Taxonomy verification
- Digital credential file creation
- Provider database management
Provider Profile Creation & Management · Benefits
- Provider profiles that are accurate
- Simple future enrollment
- Centralized provider records
- Easier credential maintenance
License & Certification Verification
Verification is comprised of Our experts verify professional certificates and licenses prior to paying for the service.
- Medical licenses
- Nursing licenses
- State licensing boards
- DEA registration
- Controlled chemical licenses
- Specialty certifications
- Board certifications
- ACLS/BLS certifications (when appropriate)
- Professional memberships
- Continuous education verification
License & Certification Verification · Benefits
- Reduced payer delays
- Accurate licensing records
- Support for compliance
- Faster credentialing decisions
Primary Source Verification (PSV)
Verification is comprised of Primary Source Verification (PSV) is an essential component of credentialing the payer. We check credentials directly with primary sources that are authorized as required by the policies of payers.
- Medical education
- Training for residency
- Fellowship education
- Board certification
- State licenses
- DEA registration
- NPDB queries (where relevant)
- OIG exclusion screening
- SAM exclusion checks
- Review of professional sanctions
Primary Source Verification (PSV) · Benefits
- Compliance of the payer
- Accuracy of credential information
- Credentialing risk is reduced
- Proficient Audit readiness
Insurance Payer Application Submission
Supported enrollment includes We provide credentialing applications to insurance companies, both public and private programs.
- Medicare
- Medicaid
- Medicare Advantage plans
- Insurance companies for commercial purposes
- Managed care companies
- PPO networks
- HMO networks
- Workers"Compensation networks
- Networks of Behavioral Health
- Specialty payor programs
Insurance Payer Application Submission · Benefits
- On time submissions
- Administrative work is reduced
- Complete payer enrollment
- Tracking submissions in a systematic way
Credentialing Status Tracking
The services of tracking are The process of obtaining credentials does not stop with the submission. We monitor the progress of applications until the final approval.
- Monitoring the status of an application
- Missing documentation alerts
- Communication to the payer
- Monitoring of processing timelines
- Escalation management
- Provider updates
- Internal reporting
- Expected approval estimates
Credentialing Status Tracking · Benefits
- Full visibility
- Identification of issues faster
- Reduced processing delays
- Improved provider experience
Insurance Network Follow-Up · Services include
Our credentialing experts are proactive in communicating with the departments responsible for approving credit cards of payers to aid in the progression of applications through the process of review.
- Regular payer follow-up
- Requests for documentation
- Corrections to applications
- Escalation support
- Updates on the Credentialing Committee
- Network participation follow-up
- Provider effective date confirmation
- Enrollment completion verification
Insurance Network Follow-Up · Benefits
- Faster enrollment completion
- Reducing waiting times
- Improved communication
- Improvements in approval times
Credentialing Issue Resolution
- We can identify and address problems that could delay enrollment.
Credentialing Issue Resolution
Resolution Services are
- Corrections to applications
- Missing document resolution
- License discrepancy resolution
- Corrections to CAQH
- NPI issues
- Taxonomy corrections
- Payer demographic updates
- Credentialing appeals help
- Resubmissions for enrollment
- Corrections to records of Providers
Credentialing Issue Resolution · Benefits
- Denials reduced
- Faster approvals
- Lower administrative burden
- More successful enrollment
Provider Types We Credential
We provide credentialing to various healthcare professionals, which includes:
- Physicians (MD & DO)
- Nurse Practitioners (NP)
- Physician Assistants (PA)
- Certified Registered Nurse Anesthetists (CRNA)
- Clinical Nurse Specialists (CNS)
- Certified Nurse Midwives (CNM)
- Behavioral Health Providers
- Psychologists
- Psychiatrists
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Marriage & Family Therapists (LMFT)
- Physical Therapists
- Occupational Therapists
- Speech-Language Pathologists
- Chiropractors
- Podiatrists
- Dentists
- Oral Surgeons
- Optometrists
- Ophthalmologists
- Pharmacists
- Durable Medical Equipment (DME) Suppliers
- Home Health Agencies
- Rural Health Clinics (RHC)
- Federally Qualified Health Centers (FQHC)
- Ambulatory Surgery Centers (ASC)
- Hospitals and Health Systems
- Group Medical Practices
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Benefits of partnering with ZechionMed
Faster provider enrollment timelines
- The onboarding process is streamlined
- Reduced errors in credentialing
- Organizational document management
- Better communication with the payer
- Monitoring of applications on a continuous basis
- Multi-state credentialing is supported
- Improved compliance with requirements of payers
- Lower administrative burden within the internal administration
- More efficient operation
- Credentialing and scaling support for expanding practices
- Experts in U.S. healthcare credentialing professionals
- Fast turnaround and quick customer service
- Continuous coordination with practice and revenue cycle operations
Frequently Asked Questions
Initial credentialing for providers refers to the procedure of confirming the qualifications of a new healthcare professional and enrolling them in insurance organizations, Medicare, Medicaid, hospitals and other payer networks prior to when they can be considered an inside-network healthcare provider.
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Talk to ZechionMed about new provider credentialing (initial credentialing).