Credentialing and Enrollment
What is Credentialing?
Credentialing is a basic primary step for any Provider or Entity in order to start submitting the claims.! One must have to establish connection with insurance companies in order to bill out the claim(s) – and for that he needs to go through the Credentialing. Process of credentialing, if explained briefly, acquiring of documents & submitting it to designated representative to get a provider credentials uploaded or updated. Thus, keeping the insurance database up-to date with provider demographics so that he gets PAID for the CLAIMS he billed.
What is Enrollment?
Enrollment is a secondary step taking place right after the credentialing is completed. Enrollment is a process in which provider can select to opt-in and/or opt-out with insurance networks and thus gaining the status of participating & non-participating respectively. Having yourself enrolled is as important as it is to get credentialed.
Why Credentialing is Important?
Credentialing & Enrollment is increasingly becoming important in healthcare industry as healthcare organizations & providers are looking for ways to ensure greater patient safety, reduce costs, as well as protect healthcare institutions from harm. Assessing and confirming the qualification of healthcare professionals can save healthcare organizations & providers from a number of liabilities, including fiscal loss, incompetent healthcare providers, risk of compliance violations, and unwanted lawsuits. In order to have a solid patient base, a healthcare professional should consider being credentialed with insurances. Also, Credentialing improves patient trust on chosen healthcare provider and it also helps them in preventing revenue loss.
WHY VMBS?
Access to the Credentialing system to monitor your progress with 100% transparency. Improved turnaround time of your provider enrollment applications and contracting process. 24/7 Support by experienced staff who work as your advocate with insurances.Strategic & detailed reports available at your palm 24/7 with updated statuses. Break down by each entity & facility in order to make you understand where actually you are standing with credentialing. Online web portal for each insurance and facility has been setup by our web-team and shared with respective client as well. Work closely with Billing Team/Operations and make sure the submission goes smooth, the claims will be released as soon as we have approval in hand. Maintain copies of contracts and e-contracts in a shared path with access given to clients. Follow through with insurances and facilities bi-weekly and weekly spreadsheet rotation to clients to keep them up-to date. Paperless applications (where applicable) and will take minimal time to setup. Maintenance of CAQH profiles and our specialized team make sure that No Certification Go Expire. We have a systematic check & balance on each item.
Insurances
Commercial Insurance Provider Enrollment and Credentialing & Re-Credentialing (Blue Cross Blue Shield, Anthem, Cigna, Aetna, Humana, United Healthcare, Tricare, and any other plan) Medicare and Medicaid Provider Enrollment and Credentialing Medicare and Medicaid Revalidation PECOS training videos on request CAQH Registration NPI Registration (Type I and Type II) Licensing (new and renewal) Negotiations on rates and reimbursements Address change projects Claims submission setup and electronic remittance setup (837/835) Electronic funds transfer or direct deposits setup.
Surgery Center & Hospitals
Each and everything is documented. A team of experienced resources is working on facilities center enrollment List of documentation is shared well before in-time to and anything in your certification is about to expired we are liable to inform you about that as well. New providers who are looking for privileges in any surgery center is catered and guided through the process with minor details. Application for re-appointments are catered 90 days before the timeline. Online portals for each facility has been share with clients & also have it uploaded on shared path. Providers who are interested to see patients in any facility under a group/clinic- You came at the right place, we are handling that too.