Credentialing Services

Start seeing new patients in weeks, not months

It’s easy enough to decide on your organization’s name, structure, and logo, but if you start doing credentialing incorrectly, you may have to wait months before you can start seeing new patients, not to mention the delay in your cash flow. CMM has been helping new and established practices with their credentialing needs since 2007. We can help you, too, whether you are a solo or multi-physician practice in an office or hospital.

An incorrect or delayed enrollment can cost you, on average, $100,000 annually for single primary care providers and $300,000 annually for specialty care providers. Increase your cashflow by letting us do your credentialing correctly and in a timely manner.

We credential with CAQH, Medicare, Medicaid, and other commercial insurances. Commercial carriers take on average 30-45 days, but Medicare still takes 90-120 days. Some commercial carriers are very slow, but as a rule, your slowest payers are Medicare and some state Medicaid programs. We track each application and utilize our relationships, developed through the credentialing of many providers, to quickly advance the credentialing and contracting process.

Medical Credentialing Company in Irving TX

Our Step-by-Step Physician Credentialing Process

Week 1: Strategy and Information Gathering

  1. Gather personal and organizational information, including CV, license information, Tax ID, NPIs’ practice address, pay-to address, etc.
  2. Decide which payers list the provider(s) wants to credential.

Week 2: Application Submission

Start filling out and submitting applications online or on paper for CAQH (Council for Affordable Quality Healthcare), Medicare, Medicaid, Tricare, and other insurance companies that do not participate with CAQH.

Weeks 3-5: Follow-Up

  1. After the application to join the network is submitted, the follow-up process starts and continues until everything has been finalized.
  2. Rigorous action is taken to make sure that the application is not pending for corrections or missing document(s).
  3. During this period, we continue to follow up and should begin to see the application making though the payers credentialing process.
  4. Once the application has made it through the initial process, we will ensure that it transitions smoothly in the contracting phase.

Weeks 6-12: Contract Negotiations and Effective Dates

    1. Agreements start coming in. If needed, payers agreements are reviewed and negotiated; otherwise, agreements are submitted to the provider for their signature.
    2. After the provider signs, these agreements are returned to the payers for loading. The loading process with some payers, such as Medicare or Medicaid, can take an additional 30-45 days.
    3. We ensure that the effective dates to start seeing patients, as well as provider IDs for the applicable payers, are received.
    4. Finally, we provide this information to your billing/administrative department or to your billing company so that you can start seeing uninterrupted cashflow.

CAQH Registration

CAQH has an online database for storing provider information and sharing it with insurance companies. Many insurance companies require providers to use the CAQH database so that they can obtain credentials directly during enrollment.

Steps:

  1. Create secure Username and Password.
  2. Complete the application and submit the required documentation.
  3. Fax signed attestation to certify the accuracy of the application.
  4. Grant insurance companies access to the online application.

Medicare Enrollment

Medicare enrollment can cost you thousands of dollars in lost revenue if done incorrectly. We specialize in all aspects of medical enrollment and will work to enroll you quickly and correctly with your local Medicare administrator. We can get you credentialed faster through PECOS (Prover Enrollment, Chain and Ownership System) because as we already have an active account with PECOS.

Steps:

  1. Start credentialing through PECOS.
  2. Submit enrollment application for individual physician and non-physician practitioners.
  3. Submit enrollment application for Clinics/Group Practices and Certain other Suppliers.
  4. Submit enrollment application for Reassignment of Medicare Benefits (individual physicians and non-physicians).
  5. Upload signed attestation and documents.
  6. Follow up in a timely manner to ensure application is complete and all the documents are uploaded.
  7. PTAN (Provider Transaction Access Number) is issued by MAC (Medicare Administrative Contractor) upon approval of enrollment.
  8. Submit EFT application for the transfer of electronic funds to the provider’s account.

MEDICAID ENROLLMENT

Medicare and Medicaid are separate programs. Submitting an application to Medicare does not mean you have also submitted an application to Medicaid. An enrollment approval in Medicare does not guarantee enrollment approval in Medicaid. Therefore, a separate enrollment with Medicaid is required.

Steps:

  • Create a secure account and obtain User ID and Password.
  • Submit application online for individual practices, group practices, and organizations.
  • Upload required documentation.
  • Attest to certify the accuracy of the application.
  • Submit EFT application.

PPO/HMO Enrollment

PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) are two different programs. Both plans use a network of physicians, hospitals, and other healthcare professionals. Credentialing with PPO and HMO carriers is done separately as per the provider’s request to join the network.

Steps:

  1. An application is obtained from the insurance carriers.
  2. A complete application with documentation is submitted.
  3. A contract is negotiated on behalf of the provider.