Staying on top of physician and provider credentialing are the most important tasks to keep cash flowing for new, changing, and growing practices. Proper medical credentialing eliminates many of the cash flow pitfalls seen in changing practices.

Practice Management provides Complete Credentialing Services for physician billing service clients, including all payer, physician group, and hospital credentialing. We also handle CAQH and NPI applications and updates. The Practice Management credentialing team maintains contact and tracks the progress of every enrollment through completion. We keep a record of every credentialing document and communication so you can focus on your growing organization! A few of the credentialing services we offer include:

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Credentialing Services

  • Medicare enrollment and revalidation
  • Medicaid credentialing
  • Blue Cross and Blue Shield
  • Commercial Payers
  • Workers Compensation Payers
  • Durable Medical Equipment
  • Hospital applications
  • Physician organizations
  • CAQH Credentialing
  • NPI Registry
  • Panel analysis

Enrollment Applications or Updates

  • Medicare full application and revalidation
  • Medicare address change
  • Non-Medicare full application
  • Non-Medicare address change
  • CAQH Full
  • CAQH Update
  • Obtain NPI
  • EFT
  • ERAs – Simple additions or changes
  • Medicare 855b
  • Medicare 855i
  • Medicare all forms
  • Address Change – All Plans

Primary Source Verification

Primary Source Verification is an important step in maintaining provider compliance and can remove barriers to proper credentialing, which keeps revenue flowing into your health center. It is the responsibility of the organization to complete Primary Source Verification, not the responsibility of the individual provider.

Practice Management offers a comprehensive Primary Source Verification Service Package to our clients. Practice Management will maintain all data needed for Primary Source Verification in its provider platform, including data on Licensed Individual Providers. All data will be maintained and housed in cloud based software, readily available to the provider and Practice Management. A Primary Source Package will be provided to Group for privileging committee. This service includes:

  • Verification of Clinical License, CDS or CSR License, Education or ECFMG if foreign medical graduate, staff identity, fitness for duty, and Board Certification
  • Completion of a query through the National Practitioner Data Bank (NPDB)
  • Drug Enforcement Administration (DEA) registration
  • Current documentation of basic life support training, PALS, ACLS
  • Immunizations, and communicable disease status; Current TB test results within past 12 months, Hepatitis B vaccination. We will follow your organization’s vaccination policy.
  • Verification of current clinical competence
  • Verifications required for renewal of privileges, including peer reviews and references
  • Copy of FTCA
  • Consent and Release of Liability & Acknowledgement Statement
  • Documentation of CMEs for previous two years
  • OIG Query
  • NPDB Query
  • Delineation of Privileges
  • Current Resumes
  • Collaborative Agreements as needed by states
  • System for Award Management verification

Practice Management credentialing services are available to current billing clients or as standalone credentialing packages for multiple providers. Services are not offered for individual providers.

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