Medical Credentialing Services

Your Trusted Partner In Provider Credentialing and Enrollment

With Neolytix provider credentialing and enrollment services, your healthcare organization can maintain high-quality care standards without unnecessary stress or delays.

Advanced Credentialing Solutions for Modern Healthcare Providers

Physician credentialing is verifying and assessing a physician’s qualifications, training, experience, and licensure to ensure they meet the standards required to practice medicine within a healthcare organization.

At Neolytix, we provide tailored provider credentialing services for healthcare organizations. Our services include automated verification, real-time updates, and personalized support. We make your operations smoother, saving you time and resources while ensuring compliance and accuracy.

medical credentialing services

Our Comprehensive Physician Credentialing Services

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.

Provider Enrollment

We assist healthcare providers in enrolling with insurance networks, Medicare, Medicaid, and other payer organizations by completing and submitting enrollment applications.

Ongoing Monitoring and Re-credentialing

By proactively managing credentialing requirements and monitoring changes, we help healthcare organizations maintain regulatory compliance and streamline administrative processes. 

Hospital Privilege Credentialing

Neolytix provides comprehensive support for hospital privilege credentialing. Our expert team navigates credentialing requirements, expediting the approval process and enabling healthcare organizations to focus on delivering quality care without administrative burdens. 

We assist healthcare organizations and providers in the application process for various licenses essential for practice, including:

  • Physician Licensing
  • Non-Physician Licensing
  • DEA Licensing
  • CDS Licensing
  • CLIA Licensing
  • Group Licensing

Neolytix specializes in negotiating favorable payor contracts for healthcare organizations, leveraging industry expertise and data analytics to optimize reimbursement rates and contract terms. 

Transform Your Credentialing Process with Technology

Neolytix CVO’s platform Incredibly puts large healthcare organizations in the driver’s seat of seamless credentialing. The Continuously Learning Platform, with Annual Major release updates is disrupting the way hospitals, clinics, etc, approach their credentialing processes. Here’s why: 

incredibly

Provider Onboarding Portal

Neolytix’s inCredibly™ is a proprietary platform tailored to streamline the onboarding process for larger healthcare organizations. This innovative solution ensures swift and compliant onboarding of new providers, leveraging advanced features to enhance efficiency and accuracy throughout the entire onboarding journey.

  • Azure Enterprise-Class Secure Cloud
  • Real-Time Status Updates
  • Expiration Alerts
  • Secured Document Storage
  • Automated Workflows
  • Pre-populated Forms Library

Network Research

Recommendations on the most popular and effective in-network Payer mix for your group or practice.​

Out of Network Enrollment

Out of Network enrollments - Our team helps with NPI registrations on the Payer’s websites.​

Closed Panel Appeals

Requests for appeals on sometimes closed panels – while not guaranteed, we see a 35% success rate.​

CAQH, PECOS Maintenance

We maintain and update your CAQH, PECOS profiles, making sure all information is accurate.​

Demographic Update

Update a new TAX ID, address changes, bank account, set-up of ERA and EFT enrollments.​

Provider Roster Management

Maintain active providers, expiration management in a secured application.​

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.

physician credentialing services

Start your credentialing journey with Neolytix’s CVO service. We handle new applications, demographic changes, portal verification, and maintain CAQH and PECOS.

This solution is efficient and comprehensive, designed for simplicity, and priced per transaction with a minimum commitment of $1,000.

Optimize your credentialing experience with a dedicated team exclusively committed to your Provider Onboarding, Primary Source Verification, Credentialing, Enrollment, and Maintenance needs.

This solution allows you to choose a customized scope that aligns with your specific requirements. With a commitment of at least 1 full-time equivalent (FTE), ensure a dedicated and efficient approach to your credentialing processes.

Elevate your credentialing capabilities with Neolytix CVO’s Analytics & Automation capabilities.

This option makes your credentialing processes more advanced by providing custom reports for Management Dashboards using Power BI & Dataverse.

Benefit from seamless integration with EHRs like EPIC, eCW, Athena, AMD, ensuring a streamlined and efficient experience. Choose Neolytix for enhanced analytics and automation, transforming your credentialing insights into actionable intelligence.

Medical Credentialing Expertise Across Diverse Specialties

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Streamline Credentialing:
Stay Prepared, Avoid Disruptions

Use our comprehensive checklist to gather the necessary information and minimize errors. This will help you overcome the obstacles and slip past the red tape to make the credentialing and enrollment process smoother.

Why Choose Neolytix for Physician Credentialing Services?

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12+ Years Nationwide Experience

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Efficient Provider Network Expansion

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Round-The-Clock Availability

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Scalable Services

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RPA & API Proficiency

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Flexible Pricing Options

TESTIMONIALS

Listen to what our clients
have to say

Sarah Charmchi
Sarah Charmchi
I chose Neolytix for credentialing our practice. The team was knowledgeable, responsive and kind and supported us through the process. I would certainly recommend their services.
Sue Robbins
Sue Robbins
Neolytix has helped so much with our outstanding A/R. They are always so very willing to help and complete the task in a timely manner.
Toby
Toby
We transitioned to Neolytix a while back, having come from a billing company we were less than thrilled about. The people here have been very responsive to our needs and requests, and adapt quickly to whatever curve balls our practice throws them. They bring a wealth of knowledge to the table, and take the attitude that our success is their success.
Sandy M
Sandy M
I was a new office manager for a private practice when I hired Neolytix for credentialing assistance. Eden has been very thorough and helpful every step of the way. insurance credentialing can be so overwhelming at times, that having this task off my plate has given me a peace of mind. I know she is handling everything. Always quick to respond to questions or concerns.
Cheryl Lambert
Cheryl Lambert
Neolytix is the most professional and hard working billing company I have ever been partners with . I call them a partner because they truly are. Neolytix makes sure what they bill is accurate. Their knowledge of physician billing is outstanding. The entire team takes control and does what is necessary to make sure you get paid.

Frequently Asked Questions (FAQ’s)

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. 

Credentialing requirements vary based on the provider type, with different standards for education, training, and licensure for physicians, nurses, and allied health professionals For instance, physicians need to verify extensive medical education, residency training, and board certifications, while nurses may focus more on nursing degrees and state licensure.  

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.

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