Medical Credentialing Services
Your Trusted Partner In Medical Provider Credentialing Services and Enrollment
At Speedy Credentialing, we specialize exclusively in delivering fast, reliable, and customized medical credentialing services to healthcare providers across the United States.
What is Medical Credentialing?
Credentialing in general is used in various contexts in different fields. In this instance, the term credentialing refers Medical Credentialing or insurance credentialing. Both Medical Credentialing and insurance credentialing are used interchangeably. Physicians and other healthcare practitioners such as a hospital, a counseling office, chiropractor, Dentist, Physical Therapist, Occupational Therapist, an optometrist’s office, Urgent care, Treatment center, Social worker etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.
Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase.
Our Comprehensive Medical Credentialing Services
Provider Enrollment
We assist healthcare providers in enrolling with insurance networks, Medicare, Medicaid, and other payer organizations by completing and submitting enrollment applications.
Primary Source Verification
We ensure accuracy and compliance with regulatory standards, as we authenticate education, training, licensure, certifications, and other relevant information directly from the issuing institution or authority.
Hospital Privilege Credentialing
We assist healthcare providers in obtaining and maintaining hospital privileges by managing all credentialing documentation, verifications, and compliance requirements.
Ongoing Monitoring and Re-credentialing
By proactively managing credentialing requirements and monitoring changes, we help healthcare organizations maintain regulatory compliance and streamline administrative processes.
Payor Contract Negotiation
We help healthcare providers negotiate favorable payor contracts to maximize reimbursement rates and streamline revenue cycles. Our experts ensure fair terms while maintaining compliance with regulatory requirements.
License Verification
We provide thorough license verification services to ensure all healthcare professionals meet regulatory and credentialing requirements. Our process helps maintain compliance and supports patient safety.
Trusted Over 5000 Client in the US
Simplify enrollment, ensure compliance
At Speedy Credentialing, we simplify medical credentialing and enrollment, ensuring compliance while minimizing administrative overhead. Our streamlined process allows healthcare providers to focus on delivering exceptional patient care rather than dealing with credentialing roadblocks.
Onboarding
We make recommendations and help you select the insurance companies you want to be networked with. You complete our master survey, and send in applicable documentation.
Application
We obtain all up-to-date insurance applications and complete them on your behalf within five business days of receiving all necessary documentation from you.
Follow Up
We follow up to make sure all applications have been received. We proactively follow up to ensure the enrollment process moves forward effectively and without delays.
Completion
We will inform you about all insurance approvals as soon as we receive confirmation. We will send you all applicable information from the insurance panel. You’re now ready to see clients and bill for services!
Tailored Credentialing Solutions for Healthcare Organizations
Catering to larger healthcare organizations means being able to offer agility to adapt to their changing demands fast. After 12 years of servicing healthcare organizations nationwide, we have refined our offerings to cater to the diverse needs of our clients.
Insurance Plans: Covering more Services than Ever
Medical credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include mental health and behavioral health parity, as well as fewer restrictions on pre-existing conditions and the coverage of supplemental services. These services include physical therapy, massage therapy, acupuncture and others. However, the cost of health insurance in the United States has increased accordingly. Persons invest heavily into their health insurance plans, and you better believe when they need healthcare services—be it general medical care, emergency medical care, dental, chiropractic, optometry, or mental health services, or anything—patients desire (even demand) to use their health insurance plans when seeking those healthcare services.
Insurance Panels: Getting Full and Closing
Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.
We are also very familiar with the licensure process of behavioral health providers, including Licensed Professional Counselors (LPC), Licensed Mental Health Counselors (LMHC), Licensed Professional Clinical Counselors (LPCC), Licensed Clinical Professional Counselors (LCPC), Licensed Independent Clinical Social Workers (LICSW), Licensed Clinical Social Workers (LCSW), Licensed Psychologists, Licensed Marriage and Family Therapists (LMFT), and many others. We understand that a designation in one state (such as LPC, LCSW) might not be interpreted as the same level of certification on another state and we can help you navigate the challenges these nomenclature variants can cause.
Every year, we at Credentialing.com provide Medical Credentialing and Provider Enrollment services that help hundreds of healthcare practices (and thousands of providers) across the United States (from New York, to Alaska, To Hawaii) become credentialed with the best 3rd party payers.
Whether your healthcare practice is looking to join the preferred provider network with Blue Cross / Blue Shied or is looking to become paneled with Medicaid, our highly-trained credentialing specialists can help.
For many healthcare providers, credentialing is a constant hassle. We, on the other hand, make credentialing easy.
Help Getting on Insurance Panels
If you’re looking for a medical credentialing service that can take the burden of getting on insurance panels off of your plate, consider us at SPEEDY CREDENTIALING. We’ve helped thousands of providers and practices get credentialed and we’d love to talk with you about our trusted and effective credentialing service. Please feel free to call us at: (959) 240-0580.
What are the typical credentials verified through a primary source verification process?
- State medical licenses
- Federal and State DEA certificates
- State Controlled Substance Registration
- Board certifications
- Medical education
- Training programs (Internship, Residency or Fellowship etc.)
- Training programs (Internship, Residency or Fellowship etc.)
- OIG, AMA, AOA, ABMS, ABIM
- EPLS/SAM
- National Practitioner Data Bank
- Medicare Preclusion List
- NPI
- ECFMG
- Medicare Opt Out list
- Medical Malpractice loss runs report
- Work History
- Hospital affiliation verification
Testimonials
What Our Clients Say
Saybah Glay
I have been working with this company for a short while now and I am more than pleased. At first I was a little scared and nervous but working with Shawn Benson has been the BEST!
Naimah Colloway
Working with Speedy Credentialing was a smooth and thorough process. They are always a phone call or email away and get back to me with speed and professionalism.
John Doe
Speedy Credentialing made the entire process seamless and efficient. Their team was knowledgeable, responsive, and kept me updated every step of the way.
Frequently Asked Questions (FAQ’s)
Why is medical credentialing important?
Medical credentialing is essential because it verifies the qualifications, experience, and professional standing of healthcare providers. This process ensures that practitioners meet industry standards and are capable of delivering high-quality patient care.
Credentialing protects patients by maintaining a high level of care and safety, while also helping healthcare organizations avoid legal issues and ensure compliance with regulations. Additionally, it facilitates smooth interactions with insurance companies, enabling providers to be reimbursed for their services.
What are the common challenges faced in medical credentialing?
Common challenges include managing complex and time-consuming verification processes, maintaining up-to-date records, and ensuring compliance with regulatory standards.
How long does the credentialing process take?
The expected duration of the provider credentialing process can vary depending on various factors, such as the complexity of the application, the number of providers being credentialed, and the responsiveness of third-party organizations involved in the process. However, on average, the provider credentialing process can take anywhere from 60 to 90 to even 120 days. Outsourcing to a reliable service provider can shorten the duration of the process efficiently and effectively.
How does healthcare credentialing differ for different types of healthcare providers (e.g., physicians, nurses, allied health professionals)?
Professional credentialing services help maintain provider networks by ensuring that all providers meet required standards, facilitating enrollments, and managing ongoing compliance to avoid disruptions in care delivery.
How do medical credentialing services assist in maintaining provider networks for healthcare organizations?
Credentialing services help maintain provider networks by ensuring that all providers meet required standards, facilitating enrollments, and managing ongoing compliance to avoid disruptions in care delivery.
Do I need a service location to begin credentialing?
Yes, having a service location is a crucial component of the credentialing. Insurance companies typically require providers to have a physical service location where they deliver healthcare services. This is where patients can contact the provider and show the provider’s presence in the community.
When you start the credentialing applications, you must give information about where you work, like the address and contact details. The insurance companies use this information to verify your eligibility and to ensure that you are accessible to patients seeking healthcare services. Having a well-defined service location is, therefore, an essential prerequisite for starting the credentialing journey.
Why do a health care organization need Primary Source Verification?
Sometimes people tend to use illegal ways of obtaining degree certificates so that they can carry unlawful work without getting caught. Utilizing fake degrees from colleges or universities, fraud work experience certification, fraud license, lying in resumes to get employment are some examples. There were multiple scenarios where some people have provided medical care and performed surgeries despite no real qualifications. This carries a significant liability risk on the health care organization. Due to these reasons many health care organizations make it their policy never to employ a provider or physician without appropriate credentialing via primary source verification.