Medical Credentialing Services

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. 

Common challenges include managing complex and time-consuming verification processes, maintaining up-to-date records, and ensuring compliance with regulatory standards.

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.

Technology streamlines credentialing by automating verification, providing real-time updates, and securely storing documents, thereby reducing administrative burdens and improving accuracy.  

Neolytix enhances this process with its inCredibly™ platform, offering features like automated workflows and pre-populated forms to further boost efficiency and compliance. 

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.   

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.  

Physician credentialing is the process of verifying a healthcare provider’s qualifications, credentials, and work history. This is done to ensure they meet the standards set by regulatory bodies, healthcare organizations, and insurance companies.

Although there might be deviations in the information requirements typically as per the insurance plans, the following is required:

• NPI Number
• CAQH profile (up-to-date)
• Practice information (Address, etc.)
• Medical License
• DEA license (If applicable)
• License to practice and primary source verification
• License history
• Insurance information
• Education: degrees and transcripts
• Board certification
• Detailed Work history
• References (Previous employers/practitioners)
• Malpractice claims history (Revocations, suspensions, etc)
• Malpractice Insurance
• Insurance login details (Medicaid, Medicare (Pecos), Availity etc.)

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.

Credentialing is about joining insurance panels to bill as an in-network provider for medical or insurance purposes. Primary Source Verification is the process of checking a provider’s credentials directly with the original source.

Healthcare organizations must verify the authenticity of degrees, work experience certifications, and licenses. This is necessary to prevent liability caused by providers using fraudulent methods. For instance, using fake degrees or falsifying resumes to get employment poses a significant threat to healthcare organizations. To prevent risks, healthcare organizations require doctors and providers to verify their credentials before hiring them.

Healthcare organizations can confidently maintain compliance with credentialing requirements, ensuring the delivery of safe and effective patient care, by partnering with Neolytix.   

Neolytix conducts periodic reviews and audits of credentialing files to ensure all documentation is current and meets regulatory standards. Our state-of-the-art credentialing management software tracks expiration dates, renewals, and updates, guaranteeing timely action on all credentialing tasks. 

We keep your staff informed about changes in credentialing requirements and regulations through regular training and updates. Neolytix also ensures accurate and complete documentation of all credentialing activities, including verification of licenses, certifications, and professional qualifications. 

Our expert compliance team oversees the credentialing process, ensuring your organization adheres to all guidelines and standards. Neolytix regularly updates policies and procedures to align with current federal, state, and industry regulations, keeping your organization in full compliance. 

In addition, healthcare organizations can ensure ongoing compliance by implementing continuous monitoring and re-credentialing processes, supported by advanced technology platforms like Neolytix’s inCredibly™. 

Yes, medical credentialing can be outsourced. Outsourcing to a specialized provider like Neolytix offers improved efficiency by leveraging advanced technology, human expertise, and relationships with payors. It reduces the administrative workload for healthcare organizations, allowing staff to focus on patient care.  

Additionally, outsourcing provides access to credentialing experts who ensure thorough and accurate verification, enhancing compliance with regulatory standards and minimizing the risk of errors or delays. This approach also offers scalability, allowing organizations to adapt to changing needs without overextending internal resources. 

1. Verify NPI Registry for correct information and taxonomy. 
2. Check CAQH profile, ensure documentation is up-to-date and re-attested. 
3. Confirm with insurance if group/provider is contracted with requested payor. 
4. Fill out appropriate paperwork to get provider/group contracted. 
5. Review all paperwork carefully before submitting the application. 
6. Submit the application to the payor to complete the contracting process. 
7. Follow up every 2-3 weeks to ensure timely processing  
8. Informing providers on credentialing process approval 
9. Facilitate contract execution between the provider and Insurance enrollment plan.  
10. Confirm the effective date of in-network is the same or as close as possible to the initial request date.

We offer a full spectrum of credentialing services tailored to mental health and behavioral health providers. This includes mental health credentialing services, behavioral health credentialing services, and mental health insurance credentialing services. Our team ensures that your practice meets all necessary compliance requirements, navigates insurance panels efficiently, and maintains up-to-date credentials, allowing you to focus on delivering quality care to your patients.