Credentialing

Medical Credentialing Services

Provider enrollment and credentialing is a crucial factor in the success of any medical practice. It is time consuming and complex and often given the least priority in the list of all that needs done. Unfortunately, when it lapses patient care and practice financials are deeply affected.

Allow STI to handle this integral process for you. We are a proven company you can trust, with 40 years in the medical field. Our diligent and experienced staff will focus on your credentialing needs, which will allow you and your staff to focus on patient care. No practice or request is too small.

Pricing:

  • $195 per payer
  • $120 per payer (discounted pricing for STI RCM clients)
  • Full-service completion of insurance enrollment applications
  • Ongoing maintenance of participating status (re-credentialing)
  • Completion of CAQH application
  • CAQH maintenance – Re-attestation every 120 days
  • Consistent payer follow up throughout the entire process
  • Secure provider portal for HIPAA compliant exchange of information and forms with DocuSign integration
  • Status updates sent bi-weekly, and/or upon request

What is meant by provider credentialing?

The provider credentialing is a process of authenticating the accuracy of provider’s educational documents, career record, malpractice history, licenses, diplomas, certifications, and professional references upon hiring. Providers must be credentialed with the payors and insurance companies to get paid and the process includes NPI and CAQH ProView.

Why is credentialing needed?

Credentialing is needed to get physicians enrolled with the insurance company. Without credentialing, providers cannot file claims to insurance companies and confidently expect reimbursements. Credentialing determines the eligibility of the providers.

How long does the credentialing process take?

The credentialing process takes around 90-120 days and sometimes the process completes quicker if the documents are complete and there are no objections.

How can I speed up my credentialing?

To speed up the credentialing process you must proactively gather the required documents, hire a credentialing services provider and ensure accuracy of the information provided.

How long does it take to credential a provider with Medicare?

The good thing about Medicare is that the day they receive the application, providers can bill from that date. Medicare takes 60 – 90 days to complete the credentialing process.

How long does it take to credential a provider with insurance companies?

The insurance companies take between 60 – 90 days to verify the provider’s educational documents, qualifications, past work experience, and checking the criminal record.

How frequently does a provider need to be re-credentialed for commercial payers?

Commercial payers usually review provider agreements every 3 years, and most organizations require complying with the re-credentialing during this period to ensure provider network quality. Some healthcare facilities or insurance companies perform recredentialing even more often.

Why does credentialing take so long?

The credentialing process can take up to 3 months to complete. Every organization has a different process to vet the sign-up application and usually, an in-house committee scrutinizes the application form every angle.