We are problem solver
We solve problems
The problem to solve.
- Most credentialing agencies separate the process. What we mean by that is one representative will process Medicare, the other will do Medicaid, and the other will do managed care, or even break it down to one more person to do Medicare Advantage or Commercial.
- This setup can frustrate organizations or providers because the other person will need to wait for one person to give them the information, which could take days or weeks for them to respond to your inquiry.
The solution.
- Here at Healthcare Credentialing & Consulting LLC, we streamline the application processes to one team that knows everything.
- If you have issues with credentialing with any insurance payor, everyone on the team will know. If your claims are denied, the team representative or anyone on the team can contact the payor and respond to you the same day to inform you about the information gathered from the payor.
- You do not need to wait days or weeks to get a reply from us.
- We will assign a dedicated team for you or your organization— everyone on that team can answer your questions.
- We will provide you with a detailed status report.
The process.
- When you first sign up with us, we ask you questions. You tell us the problem, and we offer solutions—it's as simple as that.
- We will not complicate things for you.
The steps of solving the problem.
- We will collect the information from you. If your issue starts, the payor denies or rejects your claims. We will contact the insurance company to check your status and then explain what we gathered from the payer to you the same day we acquired the information.
- Or, if your issue is becoming a participating provider with a particular insurance, we can submit your application the same day we collect the information from you.
- We will not make you wait. Your questions will be answered the same day we receive the payor's response.
- We can start analyzing and resolving the issue with the information we have collected as soon as possible.
- We also need your cooperation, so you must provide us with all the information we need to do our job.
- The faster we get your information, the quicker we can solve your issues.
WE VERIFY AND FOLLOW UP
The process of getting you approved by the insurance company.
We verify your information.
- The process starts with verifying the provider’s qualifications, including education, licensure, board certification, work history, and any disciplinary actions. .
We submit your application
- We submits applications to each payer you wish to be in network with. This application includes all the necessary documentation like licenses, certifications, malpractice insurance, and more.
We do weekly payer follow up:
- Each payer reviews the application and determines if the provider meets their standards. This review can take weeks to months, depending on the payer and the complexity of the application. We do weekly follow up with the payer. These makes our record up to date.
We assist with contracting
- Once credentialed, providers enter into contracts with payers. These contracts outline the terms of service, reimbursement rates, and other essential details.
We monitor Re-Credentialing :
- Providers must be re-credentialed periodically (usually every 2-3 years) to ensure they continue to meet payer requirements.