Medical Credentialing Services
1. What should you expect from your Credentialing Company?
The process should begin with reviewing your specific network needs or an evaluation of the top payers in your area. Once final decisions are made, a contract is executed for the work to be done and payment is made. The Credentialing team gathers all necessary documents from the provider and contacts the insurance companies to begin the application process. For most companies, the process can be completed online through their portal for form completion. If not, they will be filled out and then sent via the required method. After submitting the applications, timely follow-up with the payers is crucial to ensure they were received. We give bi-weekly status updates to the client to keep them informed throughout the process until an effective date of enrollment is determined and a contract is received and executed, so the provider can begin claim submission.
2. When you outsource your Credentialing, what does that company provide you?
Outsourced Credentialing companies should respond to requests timely and provide excellent communication and complete transparency. A provider should work with a company that is professional and caring, taking ownership in the process as your representative in dealing with the insurance companies.
3. How does PrognoCIS provide a complete Credentialing service?
We assign them a Credentialing representative that they can communicate easily with and rely on. We offer to analyze their payers for their specialty and geographical location, as well as evaluate their contracts. We want providers to feel as though we are sitting in their office and are available when they need us.
4. How long does the Credentialing process take?
The credentialing process generally takes between 90-120 days. We send a checklist of all documents that are required so that we can begin. Once they are received, we upload your data into our system and work to get your applications completed and submitted to insurance companies. We then follow up regularly with insurance companies to make sure that your credentialing applications are received and being processed and approved without unnecessary delays.
5. Do you have experience credentialing my specialty or for providers in my area?
Yes, we have credentialed for providers across the United States, including Hawaii, and for a variety of specialties and practice sizes!
6. Do you offer any service to keep up the documents and insurance contracts that expire and must be renewed?
Our Re-Credentialing and Maintenance package tracks expiration dates and renewals of contracts for your networks, such as BCBS, Aetna, and Cigna, as well as the various plans you are enrolled with under their umbrella, including Medicare and Medicaid re-validations. We also provide CAQH maintenance and attestation every 3 months, notifying the provider of expiring documents such as Malpractice, License, DEA, etc.