The Credentialing Process: What Is It?

The provider will be unable to bill the payer if the payer is not credentialed by the provider. If the insurance company denies a claim, there is usually a time limit for resubmitting the claim. It is even more problematic if the patient has a secondary insurance policy, since the longer you wait, the less likely you will be able to recover the maximum (or any) amount from the insurance company.

The hassle of submitting and tracking credentialing and enrollment applications based on insurance plan requirements (and there are many) can be eliminated with a reliable and efficient credentialing and enrollment service.

Contracting is all about accuracy, efficiency/timing, and eliminating costly mistakes in the onboarding cycle, which is very typical in the cycle. Some of the biggest challenges are.

• Following up with insurers on the status of the provider’s credentialing application. Payers tend not to call back if something is missing from the application. Document all follow-up phone calls and online communications throughout the credentialing process.
• Keeping your billing system updated with payer information: Electronic Data Interchange (EDI) enrollment.
• Examine the fee schedule before you enter into a credentialing contract with an insurance company. The payer may need to be provided with your top ten billing codes and a tentative fee schedule.
• Keep copies of all the credentials and contracts you submit, along with the letters of credentialing and enrollment you receive from insurers.

Our specialty is working with DMEPOS Providers to manage their payer enrollment process by providing a Complete Management Solutions .  Partnering with Wonder Worth Solutions allows you to experience your credentialing and contracting process the way it should be – honest, simple, efficient, and transparent. 

Provider credentialing and enrollment are simplified with a better revenue cycle management partner such as WWS reviewing and gathering documentation to determine the provider’s participation.

Get started with the nation’s leading provider of credentialing & Contracting  services Wonder Worth Solutions. 

https://wwscredentialing.com/contact-us/