Our experienced credentialing teams work closely with the insurance system and process each document with the accurate required information to deliver unambiguous provider enrollment and credentialing services.
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There are many possible problems and results in the medical credentialing application process. Healthcare provider enrollment or credentialing is one of the most critical compliance issues in physician’s practices. Without proper supervision and details understanding, deletions or misconceptions in the medical credentialing strategy can be dangerous to your organization. MedsIT Nexus delivers innovative technical medical credentialing services with a faster turnaround time.
Our experienced credentialing teams work closely with the insurance system and process each document with the accurate required information to deliver unambiguous provider enrollment and credentialing services.
The credentialing process is easy if you have a professional team and a proper credentialing system. Without knowing the standard protocols of the credentialing process, You may fail to get the application approval from your insurance company.
Our credentialing services guarantee that a healthcare provider or medical practice adheres to the letter of the state law defined by the insurance company.
Our entire credentialing process is based on the methodology that allows clinics, hospitals, physicians, and private practices to provide services to patients who have multiple insurance plans—this helps healthcare professionals streamline the practice’s financial health and boost patient visits. Our provider enrollment services also ensure that healthcare providers treat patients with the necessary qualifications and quality treatment and keep patients’ medical history.
MedsIT Nexus follows the steps mentioned below for the insurance credentialing services as per the laws of insurance companies which boost the credentialing applications process:
Although the digital revolution has accelerated the use of electronic medical records the complexities regarding medical data entry require healthcare providers to acquire data entry services. In this context, MedsIT Nexus is always available to take a look at your patient’s records that are needed to enter, organized, maintained, archive, and retrieved whether you are an entire hospital, outpatient facility, multi or a solo practitioner. Based on the scope of your requirements our concerned workforce utilizes innovative technologies to deliver you the best output.
MedsIT Nexus is among the top accredited physician credentialing companies that perform a primary source verification for the individual medical in-network provider to verify whether he acquired a valid license, certification, or registration to practice a profession as it is a primary requirement of health insurance companies.
MedsIT Nexus document verification process involves the next level of accuracy verification after the primary source verification, where the programs like Modio and Ready Doc are utilized to automate the credentialing process, including cross-referencing resume and application information with AMA profiles, medical schools, the OIG, and more.
Our professionals submit complete applications according to the payer rules. They acknowledged that even single missing information might cause approval to delay by weeks or months. Our team lists all the required documents to ensure the completion of all the applications.
After successfully submitting our initial application, payers verify our healthcare providers’ documentation, i.e., Active License, DEA, PLI, NPI, Taxonomy, etc. If all documents are up to date and additional information is not required, apps are sent to the next enrollment phase.
Once the Data Scrubbing is completed through online portals (i.e., CAQH, Availity, PECOS, Optum, ePaces, etc.) or Mailed/Faxed documents, the provider/group can successfully be credentialed in the insurance system/directory.
After getting credentialed with the payer, they proceed with our enrollment request to consider our provider/group as an In-Network or Participating Provider. Upon acceptance of this enrollment application, payers send us a formal contract & fee schedule to sign; in this way, our provider becomes a contracting & PAR provider.
MedsIT Nexus provides re-credentialing additionally in its medical credentialing services, ensuring the credentials provided by the medical practitioner are accurate and reviewing them regularly for additional verification. Our specialist uses renowned credentialing software such as Symplr Access, MedTrainer, and CredentialStream, assisting them in completing the credentialing details and submitting them to the insurance carrier, complying with NCQA and DHFS. Furthermore, our innovative software automatically alerts us when a specific provider needs re-credentialing, which helps us a lot to keep the provider stay on the insurance panel.
When a medical provider’s credentialing application is near to gets expired, the process of credentialing is re-initiated but every provider has a distinct case, their re-credentialing may include the attestations of the legal documents such as State medical license, CAQH profile, DEA license, Board certification, and proof of insurance coverage. Additionally, some of the provider’s application needs to get renewed prior to the mentioned date. In this context, MedsIT Nexus re-credentialing and expirable management services come into action that uses expirationreminder.net, Our Records, Smart Sheet, and other similar services that ensure the whole process goes smoothly without any lapse in the validity of any expirable
Healthcare professional uses CAQH to streamline their credentialing process. Maintaining the medical provider’s CAQH profile is a premier medical credentialing service of MedsIT Nexus. Our competent staff ensures to keep the documents of medical providers updated by making necessary changes and guarantees that all of the insurance companies can have access to your up-to-date credentialing information by performing consistent validation.
MedsIT Nexus is a renowned medical billing and credentialing company that delivers enrollment services with 100% accountability that ensures compliance with the National Committee for Quality Assurance and the Department of Health and Family Services.
Our expert medical billing teams verify that all follow-ups are processed satisfactorily for processing smooth application.
MedsIT Nexus credentialing teams can create and update the portals on the insurance platform to keep track of all your future claims.
Experts at MedsIT Nexus deliver provider credentialing services, addressing contracting challenges and ensuring data integrity through professional-quality audits.
MedsIT Nexus is your in-house credentialing service provider; our goal is to enroll your practice with insurance providers promptly, and maintain your insurance fee schedules so that you can continue to provide the most accurate estimates to your patients while minimizing unexpected write-offs and uncollected patient balances.
MedsIT Nexus works with your insurance panel as an extension of your practice, getting to know your specific needs and objectives for credentialing services. We become part of your team and dedicate our resources to completing the tedious paperwork of the insurance credentialing process.
Our credentialing team members are certified and have worked with multiple insurance payers in different states. We focus on streamlining the practice credentialing / re-credentialing process and updating the provider with the insurance fee schedule.
Getting enrolled with insurance payers is a very critical process, and the best way to complete this process successfully, our credentialing experts to monitor insurance payers’ requirements regularly by updating Medical licenses, DEA/CDS Board Certificates, CEUs, or anything with an expiration date and tracking the progress while updating CAQH and NPI.
Think of our credentialing experts as an extension of your team. We work diligently with our providers and guide them with insurance policies and procedures to avoid discrepancies that can interrupt practice operations.
Our credentialing automatic notification system advises practices about insurance contract renewal dates and deadlines. We send regular reminders to our clients for any document’s upcoming renewal or expiration.
MedsIT Nexus provides scalable healthcare credentialing services from single-physician clinics to large, multisite, and specialty medical facilities.
We do better when our clients do better, and that’s why we are always looking for ways to boost your practice performance, maximize reimbursement and streamline your credentialing and billing operations by implementing up-to-date policies and procedures.
Following are the standard supporting documents major leading insurance payers require
from the medical providers but are not limited to:
Certification of practicing and training
Completion of the residency program is needed in a designated specialty.
National Provider Identification Number
W-9 Form
Malpractice insurance(Active professional liability) and history
Current Curriculum Vitae with a complete professional history in chronological order and no gaps. Must ensure to add month and year.
Credentialing contact information
Letters of recommendation from providers who have directly observed the candidate in
practice within the past year are required for the assessment of clinical competency.
Considering the complexities in the medical credentialing process and meeting the regulatory regulations, we ensure the credentialing is completed within 90 days. Still, the process may delay because the turnaround time for medical credentialing varies from provider to provider.
The credentialing application process comprises a network of complex procedures with many compliance complexities. Here at MedsIT Nexus, our concerned department is equipped with a dedicated workforce who are highly aware of the insurance standard protocols and work accordingly, ensuring the process’s maximum efficiency with minimal errors.
Most commercial insurance payers require re-credentialing every year. For example, Medicare requires re-credentialing every five years, and DMEPOS suppliers require their insured medical providers to re-credential every three years. However, some states require Medicaid re-credentialing annually.
Standard Protocols of the Payers are time-exhaustive processes involving primary source data verification, accurate identity data matching, and consistent monitoring of a state board’s multitude and data sources on medical providers. These processes comprise several legislative complications, and fulfilling them takes time extensively.
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