Insurance Contracting & Credentialing

Increase Insurance Reimbursement And Streamline The Physician Credentialing Process

Managed care and government payer contracting and physician credentialing can be difficult and time-consuming processes, but today's medical service landscape requires them.

ProMD Practice Management staff has extensive experience with and a deep understanding of the managed care system. We will use our expertise and established industry relationships to help you negotiate contracts that are in line with the quality services you provide.

ProMD managed care and government payer contracting services include:

• Set up and/or keep up-to-date CAQH profiles
  • Monitor expirables with CAQH and payers including but not limited to licenses, DEA, malpractice insurance, hospital privileges
  • Complete and submit unlimited enrollment applications and hospital privileges applications
  • Follow up on enrollment applications until processed
  • Monitor CAQH profile
• Contract re-negotiation
• Individual contracting (new contracts)
• Add new providers to existing group contracts
• New practice contracting

Managed care companies and government health care payers require credentialing to ensure that medical practices and physicians meet their health care provider requirements. Hospitals also require physician credentialing before allowing hospital appointments or visits.

The complexity of the process and the level of detail required by some institutions for physician credentialing is often beyond the scope of many medical practice staffs. Even the most competent and focused individual will undoubtedly be pulled away from other duties and responsibilities trying to navigate the demanding requirements.

Physician credentialing is a tedious and time-consuming process requiring confirmation of licenses obtained, residency programs completed, services provided, and other qualifications such as references from colleagues and industry professionals. Furthermore, it could include investigations into liability claims and Department of Health and Human Services status.

ProMD’s physician credentialing experts will streamline this process by performing in-depth research and obtaining all pertinent documents. With ProMD at your side, you will experience a smooth and speedy credentialing process.

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