Credentialing
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.
In the healthcare industry, credentialing is defined as a formal process that employs a set of guidelines to ensure that patients receive the best possible care from healthcare professionals who have undergone the most stringent scrutiny regarding their ability to practice medicine.
Physician Credentialing
Feeling overwhelmed with the credentialing process or simply too busy to handle it yourself?
Let us take the burden off your shoulders and ensure it's done right.
What is credentialing?
Credentialing is the process of granting a designation, such as a certificate or license, by assessing an individual's knowledge, skill, or performance level. If any information needs to be revised after submission, the attestation will also need to be rewritten and resubmitted.
Credentialing Services We Provide!
We submit a participating request to your chosen health plans using their specified credentialing application process. Once the health insurance company receives your credentialing application, employees perform a thorough verification process. Your file will then go to the company's credentialing committee for approval. This process can take upwards of 90 days.
While this phase may feel drawn out, your dedicated Alliance Practice Management Healthcare account manager will provide you with weekly or even daily real-time application updates.
The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.
We help you through credentialing and also assist you with contracting negotiations before you sign your agreement, including:
• Reviewing the language of your participating provider contract.• Explaining the responsibilities of participation.• Ensuring you get the best possible reimbursement rates.
Once you sign your agreement, you will get an effective date and provider number. Then, you can start billing the plan and receiving your in-network reimbursements. Provider Linkage - Comprehensive review and gathering of data needed to ensure your existing provider or your new provider are linked to all of your payer contracts. CAQH ManagementNew Provider Establishment Medicare and Federal Payer Enrollment - "Medicare credentialing requirements include registering with NPPES and PECOS for physicians, verifying licensure, certification, disciplinary status, and eligibility for payment from primary and secondary sources, and updating information and performance indicators every 3 years. The application must be signed, dated, and attested by the applicant. Site visits may be required as appropriate. Newly trained health care professionals may be initially credentialed for up to 60 days. Physician LicensingNPI EstablishmentMalpractice enrollment Call us today and receive an evaluation and consultation for your practice. 650-967-2117 or CLICK HERE TO GET STARTED
While this phase may feel drawn out, your dedicated Alliance Practice Management Healthcare account manager will provide you with weekly or even daily real-time application updates.
The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.
We help you through credentialing and also assist you with contracting negotiations before you sign your agreement, including:
• Reviewing the language of your participating provider contract.• Explaining the responsibilities of participation.• Ensuring you get the best possible reimbursement rates.
Once you sign your agreement, you will get an effective date and provider number. Then, you can start billing the plan and receiving your in-network reimbursements. Provider Linkage - Comprehensive review and gathering of data needed to ensure your existing provider or your new provider are linked to all of your payer contracts. CAQH ManagementNew Provider Establishment Medicare and Federal Payer Enrollment - "Medicare credentialing requirements include registering with NPPES and PECOS for physicians, verifying licensure, certification, disciplinary status, and eligibility for payment from primary and secondary sources, and updating information and performance indicators every 3 years. The application must be signed, dated, and attested by the applicant. Site visits may be required as appropriate. Newly trained health care professionals may be initially credentialed for up to 60 days. Physician LicensingNPI EstablishmentMalpractice enrollment Call us today and receive an evaluation and consultation for your practice. 650-967-2117 or CLICK HERE TO GET STARTED