Provider Medical Credentialing Services in Rhode Island

Medical Credentialing and Enrollment Services

Struggling With Challenging Credentialing Requirements? Get Enrolled With Your Desired Insurance Carriers Efficiently and Effectively.

About Our Medical Credentialing Company In Rhode Island

Navigating the complexities of different insurance payers is tedious, but it also drives providers toward a mistake-prone process. Rhode Island insurance credentialing services are tailored to support healthcare organizations in expanding their medical treatment services across all states and insurance companies. We help you save weeks of time in filling out credentialing applications and primary source verifications, resulting in a smooth transition and onboarding with new payer networking plans. Additionally, outsourcing our enrollment services offers flexibility and minimal disruption in patient care activities, which allow your team to focus more on patient care than laborious administrative tasks.

Our Physician Credentialing Outsourcing Services

We offer a comprehensive suite of medical credentialing services that work perfectly for healthcare professionals in Rhode Island and throughout the US.

Government Program Enrollment

Experts of our company handle the entire Medicare and Medicaid provider enrollments, ensuring clinicians can offer their patient care services to these health plan beneficiaries to promote maximum prevention and timely treatments for critical and chronic diseases. We also provide support to Medicare DMEPOS enrollments, helping providers offering specialized services like durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Commercial Insurance Credentialing

Besides Medicare and Medicaid programs, our commercial insurance enrollment experts provide seamless integration with all major payers in the US. Our superior support establishes favorable terms in contract negotiation on medical services and opens the doors for maximizing reimbursement rates that contribute to the optimal function of revenue cycle management.

Essential Registrations

Our healthcare credentialing team offers invaluable assistance in NPI registration of both types, ensuring individuals and groups/hospitals avail the best privileges. In this aspect, we handle Type-1 for individual providers and extend this assistance to Type-2 for healthcare organizations. Along with NPI, we create and maintain the CAQH profile necessary for obtaining enrollment with payers.

Licensing and Certification

The best of our credentialing and enrollment services doesn’t end here. We proficiently handle state license applications for new providers and renewal of medical licenses for established practices for continuous function without disruptions. Moreover, we provide assistance to healthcare practitioners in obtaining DEA licenses, which allow providers to prescribe opiods and controlled substances to patients suffering from terminal illnesses.

Hospital Privileges

We help providers in streamlining the application process for affiliated hospitals to ensure their patients receive high-quality care from qualified healthcare experts. Privileging ensures medical providers act within the scope of their practice and provide competent patient care in line with their role at the facility. Additionally, we aid in the process of monitoring and re-evaluation of skills and competence that ensures clinicians to continue performing the approved privileges.

Ongoing Support

We offer continuous support to healthcare physicians in the revalidation and re-credentialing process so they can maintain their active status in providing medical care to patients in the payer’s network. Our 24/7 ongoing support identifies and resolves critical issues and leakages pertaining to your revenue cycle and employs the best preventive measures to meet NCQA compliance standards.

Benefits of Outsourcing Credentialing Services To Us

Outsourcing revenue cycle management solution from Rhode Island medical billing company offers billing services of top-class taking your practice to a new level of efficiency and optimal patient care.

Primary Source Verification

A provider's primary source verification enables a smoother enrollment process in the payer's system. Updated qualifications and credentials help in meeting regulatory requirements.

Streamline Workflow

Our professionals help in making this process tidy and streamline the entire process till the provider is onboard.

Empower In-house Staff

Delegating this complicated and time-consuming task empowers your in-house team, frees up their hands, and diverts efforts to more important matters.

Minimum Risk

Our expert managers fill the application with absolute perfection, helping you avoid critical mistakes that are overlooked by physicians.

Rapid Patient Growth

Utilizing out-of-network and in-network payer enrollment programs ensures rapid increases in patients and a stable and uninterrupted stream of revenue.

Time Efficient

Our dedicated experts reduce the entire time of credentialing significantly from months to only a few weeks to fasten the process.

24/7 Access

Our online platform provides 24/7 access to application status relating to credentialing, enrollment, and DEA licenses to make you aware of the progress.

Credentialing Process for Providers in Rhode Island

Our provider credentialing process is thorough and meticulous, ensuring the highest level of satisfaction with the resulting outcomes. We have achieved a benchmark success rate of 99% in getting medical practitioners approved and enrolled in premium insurance plan networks. Our credentialing specialists follow these steps to successfully enroll you in both out-of-network and in-network contracts.

Surveying the Provider

We conduct detailed interviews with physicians to gather essential information such as license numbers, academic background, and professional history.

Choosing Insurance Company

We conduct detailed interviews with physicians to gather essential information such as license numbers, academic background, and professional history.

CAQH Enrollment and Management

Our team handles the CAQH application, its submission, and the ProView account to make your credentials up-to-date for smooth primary source verification.

Fast Credentialing Approval

We take result-oriented steps in minimizing the timeline of the process by relying on precision, resulting in 20% less time.

In-Network Enrollment

Our fast-track credentialing process results in providers getting offers for in-network enrollment, resulting in successful billing and preferred reimbursement rates.

Winning Hospital Privileges Application

After successful credentialing, we help you gain maximum hospital privileges, including inpatient treatments, encounters, and surgical rights.

Frequently Asked Question

Most Asked Medical Credentialing Questions, Answered (FAQs)

How long does the credentialing process take?

The turnaround time is subject to variation among insurance carriers. The procedure is typically completed within 90 to 120 days for major carriers. It may be necessary to wait longer for insurance plans and smaller carriers.

How long does it take to enroll with Medicare?

Enrollment in Medicare normally takes 60 to 90 days, however this varies by state. The effective date for Medicare is determined by the day the application is accepted, allowing clinicians to bill for any interactions that occurred between application and approval. There is also a 30-day grace period, which allows providers to bill for services supplied up to 30 days before the effective date.

Can your experts speed up the credentialing process?

We can’t speed up the process, but we can manage it efficiently and effectively, from initial credentialing applications to carrier follow-ups. Our professionals are well-versed in the entire procedure, saving time that would otherwise be spent if providers attempted to execute it themselves and made mistakes along the way.

Do I need a service location to begin credentialing?

Yes, providers must have a place of service before beginning the medical credentialing and contracting procedure. A residential address cannot double as a clinic address, either permanently or temporarily. A home address can, however, be used for billing or correspondence, but only if a physical address for the practice is included. If office space is still being built, the address can still be used. The application can be submitted up to 30 days before the location’s formal opening, and most commercial carriers follow the same guidelines.

How do I complete Medicare revalidation?

DMEPOS suppliers are required to revalidate their Medicare enrollment every three years, in contrast to the five-year requirement for Medicare enrollment revalidation. The CMS855I paper application can be completed by individual providers, or the revalidation can be completed online using Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).

Which Medicare application is used for provider enrollment?

The CMS855I application is utilized to enroll individual providers in Medicare. It is applicable to both physicians and non-physicians. The documentation that is required by other categories of providers may differ. Providers may also be required to submit the CMS460 form in order to elect to participate in Medicare. Failure to do so may result in enrollment as nonparticipating providers. Nonparticipating providers will receive a reduced reimbursement from Medicare, but they are also permitted to pursue additional reimbursement directly from patients, up to 115% of the Medicare rate.

What is a CP575?

The CP575 is the confirmation letter that the IRS sends to providers upon the receipt of a business’s Employer Identification Number (EIN) or tax ID number. This letter is required to be submitted with the Medicare enrollment application as evidence of the business’s legal identity. In the event that the original is unavailable, a substitute letter 147C may be requested to serve as verification of the EIN. Medicare accepts only these two documents as evidence of EIN.

Follow Us On: