Provider Enrollment and Credentialing Services
There are too many manual steps involved in the process of getting a provider credentialed with a payer, such as filling out application forms, answering questions from payers, and following up to close the credentialing request. Using Revelationcare’s Provider Credentialing Services, you can keep your information current with payers.
A crucial stage in the revenue cycle is provider credentialing, which is the process of getting a doctor or other provider affiliated with payers. Through the process, patients can use their insurance cards to pay for the medical services they use, and the provider can get paid for the services they provide. To ensure that patients can use their insurance plans in their practices, healthcare providers must enrol in and obtain credentials from as many payers as possible. If they don’t, patients will look for competing providers who have enrolled in the health insurance companies to which they are subscribers.
The application forms must be filled out, payers must be contacted to close the credentialing request, and there is a lot of manual work involved in getting a provider credentialed with a payer. RevelationCare can help you obtain your credentials more quickly because we are familiar with the paperwork that each payer needs as well as their policies and procedures.
Provider Credentialing
The process involves the following steps:
- Application Evaluation. Completing the necessary paperwork and locating any exceptions.
- Primary Source Documentation. Verify the information provided by doctors about the practitioner or facility.
- Outbound Call Center. Obtain the necessary paperwork, then update the payer’s database.
- Follow-up with payers. Timely follow-ups after receiving credentialing requests.
- Data Entry. Record information, label images, and associate them with particular facilities or providers in the payer’s database.
- Maintenance of Provider Data.Update provider data in accordance with CAHQ’s profile and policies.
Provider Enrollment
Our Provider Enrollment services make sure that payers have the information they require to process claims for the services you provide, enabling practices to become enrolled for the services they offer. To ensure that applications are received and processed on time, we closely monitor the payers. We put forth a lot of effort to find and fix any potential administrative problems before they affect your provider reimbursements.
The process involves the following steps:
- Verification of provider information. Before we submit claims, we should check with payers to see if they have the right provider
information on file. - Updating practice’s Pay-to address. Authenticate and make changes to the provider’s billing address or pay-to-address.
- Enrolling for electronic transactions.
- Monitoring process. A team of experts with the requisite skills to conduct research and analysis on any potential
gaps in processor functionality.