A provider who is not credentialed with a payer cannot bill that payer. We collect the provider's details and documents, set up or update the CAQH profile, submit each payer's application and follow up until it is approved.
Provider credentialing is the process an insurance plan uses to verify a provider's qualifications before adding them to its network. Payer enrollment is the related step that sets the provider up to bill the plan. Until both are complete, claims from that provider to that plan are not paid.
Most commercial plans read the provider's details from CAQH, a shared database where providers keep their professional information and documents. We set up or update the CAQH profile, collect and verify the provider's details and documents, and submit the application each payer requires.
Credentialing timelines vary by payer, so the real work is follow-up. We record every submission date, reference number, follow-up date, pending requirement and status in a credentialing tracker, and contact each payer for status updates and missing information. After approval, we keep watching expiration and effective dates and tell you when something needs action.
Re-credentialing is handled separately from new enrollment and follows each payer's requirements, including any CAQH updates.
Our parent company, Hire My Assistants KPO LLP, is HIPAA compliant.
We sign the Business Associate Agreement your practice or plan uses, before any access is set up.
We work directly in your billing or claims system, or through the VPN or virtual desktop you provide. We never download or store patient data.
Restricted, monitored workstations, multi-factor login, encrypted devices, and access logs. No phones or writing material on the floor.
Every team member passes police verification and an outside background check, and completes HIPAA training when they join the team.
Tell us how many providers, which payers and whether this is new credentialing, re-credentialing or adding locations. We reply within one business day.