Credentialing Specialist: Getting on Insurance Panels | PracticeWorx
866-358-2499 8390 Champions Gate Blvd Ste. 215. Champions Gate, FL 33896

Our Expertise, Working for You

Your own in-house provider enrollment and credentialing specialist, increasing your revenue opportunities with effective and efficient performance

Provider Enrollment

Speeding up the medical insurance enrollment process with Medicare, Medicaid and other commercial insurers allows you to see patients faster and get paid for services sooner. PracticeWorx is your own medical insurance enrollment and credentialing specialist, increasing your revenue opportunities with effective and efficient performance.

Application processing, tracking and diligent follow-up is difficult to manage. Many providers don’t realize that a successful provider enrollment process needs to be just as important as any other aspect of running a successful practice. By reducing provider enrollment timeframes, practices can generate incremental revenue. The sooner you are enrolled, the sooner you can see patients, and thus bill and collect for services.

Whether you are starting a new practice, adding a new provider, changing practice locations, or breaking away from a group to become solo, these all require new enrollment/credentialing services. With PracticeWorx you have your own dedicated credentialing specialists to focus on your medical insurance enrollment and credentialing needs, so you can focus on your patients.

When enrolling new providers to a practice, PracticeWorx acts as your own in-house credentialing department, employing a three step credentialing process to expedite your medical insurance enrollment.

  • Step I – PracticeWorx prepares all applications including Medicare enrollment and Medicaid application. This takes approximately 7 – 10 business days once all documentation is received for the provider. 
  • Step II – PracticeWorx delivers the applications. Applications will be tabbed to indicate where additional input and signatures are required. Provider approves and signs all applications. This is provider-dependent, but should only take about one week to complete. 
  • Step III – PracticeWorx receives all applications from provider, forwards them to the insurers and follows the progress of each application. This step typically takes 30 – 120 days depending on the insurer. In some instances, this step could take longer for certain insurers.

Starting at only $200 per plan, per provider

Credentials Management

Keeping you credentialed and up to date with hospitals and insurers to maintain your revenue stream.

Along with getting on insurance panels, maintaining up to date credentials is a requirement for upholding hospital staff or facility privileges, as well as continuing as a participating provider with insurance plans. Any lapse in doing so could disrupt your ability to see patients.

PracticeWorx becomes your own in-house credentialing department, keeping you up to date so you can see more patients, not stress about paperwork.  As a member of your team, we make sure all credentialing requirements are always up-to-date and insurance enrollment for Medicare, Medicaid and any commercial insurance is handled promptly. We take the headache away from Medical Staff re-appointments, insurance re-credentialing and license renewals.

We deliver a personalized, yet team-driven focus to handle your credentialing needs of your practice. With PracticeWorx, your practice will receive a dedicated credentialing specialist, in addition to the backing of our team of professionals. So throughout the entire credentialing process, we act as your credentialing specialist for comprehensive management of your credentials from A to Z.

Highlights of our credentials management include:

  • PracticeWorx sets up the provider(s) in our electronic database, inputting all relative information, expiration dates, copies of documents, CME courses/credits earned, etc. 
  • PracticeWorx provides automated messages of expiration dates, e-mail copies of documents/reports as needed, acting as an automated, electronic medical staff file. 
  • PracticeWorx will also process/pre-populate any re-enrollment or re-credentials application for expedited completion. 
  • PracticeWorx provides the practice on-line access to the electronic database of all credentialing documents through a private, secure server. 

Starting at only $100 per month, per provider

Credentials Verification

 The process of verifying the accuracy of the qualifications of a healthcare provider from the original source of that credential is commonly referred to as Primary Source Verification (PSV). Healthcare facilities, health plans, independent physician associations (IPAs) and accountable care organizations (ACOs) are types of organizations who undertake primary source verification. These organizations must validate whether a provider is qualified and competent to provide healthcare services as a member of their staff, often times as a requirement of state and local laws and/or regulations of an accrediting body.

Here are some of the primary credentials that require verification:

  • Medical License: State Medical Board/Dept of Health and/or Federation of State Medical Boards (FSMB). 
  • Board Certification: American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA) 
  • DEA/Controlled Substance. 
  • Malpractice: National Practitioner Data Bank (NPDB) 
  • Disciplinary Actions: NPDB, State Medical Boards 
  • Sanctions: OIG, Medicare/Medicaid 
  • NPI – National Plan Provider Enumeration System (NPPES) 
  • Work History 
  • Facility Privileges 
  • Peer References 

PracticeWorx assists with the credentials verification process by:

  • Gathering of provider’s demographic and credentials information 
  • Performing all the required credentials queries 
  • Preparation of a credentialing file (electronic and/or hardcopy) for each provider 

 

Why PracticeWorx

PracticeWorx is your own in-house medical insurance enrollment and credentialing experts, increasing your revenue opportunities with effective and efficient performance.

You may be wondering “why can’t I do this myself?” Consider these benefits and facts:

  • We are simply a department of your practice: We integrate as a part of your practice, truly getting to know your needs and goals. It’s not just paperwork- enrollment and credentialing needs expertise- we become a member of your team and bring our skills to you. 
  • Working with experts enhances performance: Our enrollment and credentialing specialists focus solely on that task, making us experts at being effective and efficient at what we do. Working with PracticeWorx frees your staff to focus on strengthening day to day operations. 
  • Improved patient relationships: Spend more time taking care of patients, allow us to take care of the paperwork. We empower our providers and practices to focus on improving the patient experience. 
  • Increase revenue: Streamlining your credentialing requirements ensures consistent opportunities to generate and maintain revenue, contributing to a stronger practice overall. The faster you are enrolled, the sooner you can see patients, submit for reimbursement and collect for services provided. 
  • Reduced risk: Our specialists are a successful team focused on what they do best, keeping up with the latest laws, requirements and rules. This means you get our expertise and a more efficient process, ensuring accuracy and proficiency. 

Frequently Asked Questions About Getting On Insurance Panels

Starting a new practice, adding a new provider, changing practice locations, or breaking away from a group to become solo, all require enrolling with insurance companies in order to become a participating provider with that insurer. Patients are much more likely to seek treatment from providers who participate with their insurance plan. Thus, a benefit for becoming a participating provider is the opportunity to obtain new patients for your practice. Filling out enrollment, and re-enrollment applications for insurance companies, hospital staff privileges, and malpractice carriers is tedious and time-consuming. Application processing, tracking and diligent follow-up is difficult to manage, and many providers don’t realize that a successful provider enrollment process needs to be just as important as any other aspect of running a successful practice. By reducing provider enrollment timeframes, practices can generate incremental revenue. Using a third-party that specializes in enrollment, such as PracticeWorx, can speed up the process by ensuring accuracy and efficiency of each application submittal, while costing far less than hiring someone internally to perform these functions.

In the simplest of sense, credentials management is the process by which all of a provider’s credentials (ie. licensure and certification, staff privileges, insurance participation, continuing education) are kept up-to-date and accurate in a secure and organizational manner. Credentialing is the verification process by which insurance networks, healthcare organizations and hospitals utilize and evaluate documentation regarding a medical provider’s experience, training, work history, licensure, regulatory compliance record and malpractice history in order to permit that provider to participate in their network or treat patients at their hospital or facility. Re-credentialing typically occurs every two to three years, proving that it is more than just paperwork.  Credentialing and re-credentialing is a complex and ongoing process that can prevent or delay provider reimbursement if not completed successfully. Credentialing can be a tedious process, with seemingly endless paperwork.  Outsourcing to a specialist, such as PracticeWorx, is typically less expensive and more efficient than hiring or assigning a staff member to maintain this essential function. We think you will find it doesn’t have to be a painful experience.  You see patients, leave the paperwork to us.

We work throughout the United States of America:

Alabama Hawaii Massachusetts New Mexico South Dakota
Alaska Idaho Michigan New York Tennessee
Arizona Illinois Minnesota North Carolina Texas
Arkansas Indiana Mississippi North Dakota Utah
California Iowa Missouri Ohio Vermont
Colorado Kansas Montana Oklahoma Virginia
Connecticut Kentucky Nebraska Oregon Washington
Delaware Louisiana Nevada Pennsylvania West Virginia
Florida Maine New Hampshire Rhode Island Wisconsin
Georgia Maryland New Jersey South Carolina Wyoming
We can work with any insurance carrier, including:

Aetna Blue Shield Humana Medicare HMOs Principal
Amerigroup Champus Great West Medicaid HMOs TriCare
AvMed Cigna Guardian MetLife United Healthcare
BCBS Coventry Medicare Molina Universal
Blue Cross DeltaCare Medicaid Multiplan WellCare

Currently, we have chosen to specialize in provider enrollment and credentialing services.  This allows us to provide highly skilled support for your practice.  PracticeWorx streamlines the provider enrollment and credentialing process so you can focus on what matters, your patients.

Much of the estimated time of completion for new provider enrollment depends on a number of factors, including:

  • Does your practice need to link a new provider to the group? 
  • How many panels are you enrolling in? 
  • How many states are you licensed in? 
  • Do you have an NPI? 
  • Do you have a Medicare number? 

Many of these individual factors will directly influence how quickly you are able to complete the enrollment process. INSERT link to enrollment section/process section

Most provider enrollment needs can be completed within 4 to 8 months, circumstances permitting.

The choice to see patients prior to completing the enrollment process is at the choice of the provider.  However, one important thing to keep in mind is that you will have to bill your patients as a non-participating provider.  This means the patient is subject to 100% of your fee.  The risks and benefits of this are best determined on an individual, case by case basis.