Credentialing

  

Physician credentialing is more necessary than ever before, partly because an increased number of people in the U.S. have health insurance, but even more so because patients seek services from in-network providers to reduce out-of-pocket expenses.  Being credentialed with various payers can also have a direct impact on the growth of your business, allowing increase in patient volume due to in-network participation.

 

Credentialing or enrolling with government and commercial payers is a challenging and tedious, time-consuming process.  At Apex, we take care of everything from start to finish, with completion of credentialing applications and providing all necessary follow up with insurance carriers…we track the entire process from submission through to approval.  Our team of experts understand the unique requirements of each insurance company, and understand what these insurance affiliations mean to your bottom line.  We provide insurance credentialing services to practices of all shapes and sizes.

Medicare & Medicaid Enrollment & Reassignment

Our credentialing team will provide a review of your current credentialing status of provider enrollment, payor enrollment, NPIs and other numbers, and pay-to address administration.  We also provide assistance with identified credentialing needs including submission of enrollment forms and follow-up on status for physician(s) and/or mid-level provider(s).

Managed Care Payer Enrollment

From the time we receive your required information and documentation, it typically takes 90 – 180 days before the credentialing and contracting process is complete.

 

We follow your application through the complete credentialing process. Our persistence and knowledge of the process helps ensure that your application moves forward as quickly as possible.

CAQH Profile Management

Updated CAQH information is becoming increasingly important in the credentialing process as many payers now pull data from this universal database for provider specific information.  At Apex we assist with CAQH enrollment, and manage this database for our providers, assuring that there are no delays in the credentialing process due to outdated and incomplete data.

Re-credentialing of Providers

Today, physicians face the redundant and time-consuming process of credentialing or re-credentialing with individual health plans once every three to five years. During this timeframe, information often becomes outdated. The CAQH system provides a time-saving solution that helps ensure information is up-to-date for credentialing and payment processing, and for use in health plans' electronic and paper directories.

© 2018 by Apex Practice Solutions, Inc.

1908 N. Laurent, Suite 410
Victoria, TX 77901