MEDICAL CREDENTIALING SERVICES
Before any providers in your practice may submit claims to an insurance company (payor), they must first be credentialed by the payor. Simply put, the payor reviews and validates the experience and qualifications of the provider or practice. Upon successful completion of this process, the provider or practice is credentialed with that payor and is then able to submit claims to that insurance company.
Medical credentialing is vital to the success of any medical practice. Advanced Practice Claims have direct working relationships with key personnel at most insurance providers, allowing us to streamline the process.
APC offers competitive rates for our credentialing services. Our prices are based on the number of providers & plans, so please contact us for an accurate quote.
Maintenance & Recredentialing
As a value-added bonus, APC includes maintenance and recredentialing to our credentialing customers. We ensure that your practice and providers stay properly credentialed, and track recredentialing needs, which prevents claim denials and keeps insurance payments coming in.
CAQH Credentialing
APC is your CAQH experts! From obtaining your CAQH ID to polishing your completed CAQH profile, we do it all for you.
Click here to obtain more information about our medical credentialing services.
Are you adding a new provider to your practice?
APC will take care of everything for you, by completing the following:
• CAQH Credentialing
• Fast & Accurate Completion of all Applications for Commercial Insurance Companies
• Medicare Enrollment for Individuals & Reassignment to Group
• Medical License Application Processing & Tracking
• DEA Registration & Tracking
• NPI Registration
• Tracking & Confirmation of all insurance contracts, PAR ID’s & effective dates
Are you a new practice?
Let APC help you get started with all of some of the following tasks:
• NPI Registration
• CAQH Credentialing
• Fast & Accurate Completion of all Applications for Commercial Insurance Companies
• Medicare Enrollment for Group Practices and Individuals
• Medicare EFT Enrollment for Individuals and Groups
• ERA/EFT Set Up Assistance for Commercial Carriers
• Tracking & Confirmation of all insurance contracts, PAR ID’s & effective dates
Note: New practices are wise to plan ahead for the credentialing process, as it is detailed and requires a significant amount of documentation to complete.
Click here to obtain more information about our medical credentialing services.
Why you should use APC to manage your credentialing:
Each commercial payor, as well as Medicare and Medicaid, require unique forms and documentation. The process requires accuracy, patience, follow-up, and most importantly, time.
APC’s credentialing service doesn’t stop at the water’s edge. We diligently track recredentialing timelines, review changes in fee schedules, manage CAQH profiles, terminate providers from your contracts (as needed), and manage demographic changes.
While denied or unpaid claims are reviewed on a case-by-case basis, our proprietary software aggregates denial data and compares it to credentialing data to identify problems. For example, a number of claims are denied for invalid provider ID’s, our system would inform us of a potential problem in your credentialing.
We take your payor contracts seriously. Each contract contains fee schedules, cause for termination, and other critical information. We use these contracts to verify reimbursement rates quarterly, since most payors are not forthcoming with increases to fee schedules. Billing on old fee schedules could leave thousands of dollars on the table each month!
Click here to obtain more information about our medical credentialing services.