The process of physician credentialing and provider enrollment services involves the registration and verification that a physician is included in a Payer’s network and is authorized to deliver services to patients enrolled in the Payer’s plans. Credentialing serves to confirm that a physician satisfies the standards established by the Payer through an examination of various factors, including the physician’s license, experience, certifications, education, training, affiliations, malpractice history, adverse clinical events, and clinical judgment.

The Importance of Physician/Provider Credentialing Services Robust provider credentialing services are essential for enhancing the operational efficiency of a medical practice. Inadequate enrollment can lead to delays or denials of payments from insurance carriers, even if the physician is fully capable of delivering competent and medically necessary services.

At HANA HealthCare Solutions, we provide comprehensive physician credentialing services designed to assist providers in maximizing their revenue potential. Our customized credentialing services streamline the payer enrollment process for physicians who are:

• Initiating their first practice after completing medical school
• Transitioning from one practice to another
• Adding a new physician to an existing group
• Seeking enrollment with a new Payer

Different Payers require distinct forms to be completed, either online or via paper applications. Following submission, it is crucial to maintain diligent communication with the Payers to ensure the timely completion of the provider credentialing process, thereby safeguarding revenue flow.

Accounts Receivable Management: Top Tips to Get You Paid
While the desire for prompt payment is understandable, certain unavoidable circumstances may hinder timely payments from insurance companies. There are instances where claims may be denied by insurers. Although it is impossible to guarantee that every claim will result in payment, the likelihood of denials and inefficiencies can be reduced through effective accounts receivable management. This process may appear intricate; however, it becomes manageable when collaborating with the appropriate billing partner, which can be outsourced to optimize both cost and effort. Below are several recommendations to enhance the effectiveness of accounts receivable management.

1. The following steps are undertaken as part of HANA HealthCare’s physician credentialing services:

• Management of provider letters of interest and application requests from payers
• Establishment of new provider affiliations and group credentialing
• Credentialing of facilities, including the addition of providers to the facility’s identification
• Preparation of paper CMS 855 forms and other managed care applications for all payers, including durable medical equipment (DME) and dental payers
• Preparation and submission of online applications to federal, state, and commercial insurance carriers
• Regular maintenance and updating of specific provider information directly with carriers, either at scheduled intervals or upon request
• Resolution of enrollment issues and tracking of managed care contracts
• Preparation of contracting documents for electronic scanning and long-term storage
• Creation, maintenance, and monitoring of managed care summaries that include effective dates, fee schedule details, and group affiliations
• Monitoring of expiration dates for New York State registrations, DEA registrations, and CLIA registrations, as well as managing re-application processes
• Management of re-credentialing as necessary

Our dedicated team of physician credentialing specialists ensures that your credentialing application receives the attention it requires.

2. The following procedures are implemented as part of HANA HealthCare’s physician credentialing services:

• Processing provider letters of interest and application requests from payers
• Establishing new provider affiliations and conducting group credentialing
• Credentialing facilities, which includes adding providers to the facility’s identification
• Preparation of paper CMS 855 forms and other managed care applications for all payers, including durable medical equipment (DME) and dental payers
• Preparation and submission of online applications to federal, state, and commercial insurance carriers
• Regular maintenance and updating of specific provider information directly with carriers, either at scheduled intervals or upon request
• Addressing enrollment issues and monitoring managed care contracts
• Preparation of contracting documents for electronic scanning and long-term storage
• Creation, maintenance, and monitoring of managed care summaries that include effective dates, fee schedule details, and group affiliations
• Monitoring of expiration dates for New York State registrations, DEA registrations, and CLIA registrations, as well as managing re-application processes
• Management of re-credentialing as necessary

We guarantee that your credentialing application will receive the necessary attention from our dedicated team of physician credentialing specialists.