credentialing

Our Story...

Many inquiries for our services begin with a request for our help in getting a physician or practice credentialed with insurance companies. Since credentialing is required to start a payor contract, we are experts at it.

In order to contract with a health plan, participate in the health plan’s network, and receive reimbursement for services provided to health plan members, physicians must complete the health plan’s credentialing process.

Some of the most rigorous applications are with the government payors, and physicians are unable to see government insureds without being credentialed. Since getting paid for this growing patient population is contingent upon the successful completion of these laborious applications, we advise using an expert with lots of experience with each government intermediary. Physicians’ Ally, Inc. assists our many client practices with hundreds of Medicare, Medicaid and other government payor credentialing applications each year.

Starting a new practice?

The credentialing process may take up to 6 months or more to complete and is imperative in order to receive reimbursement for patient care on Day One. If you’re starting a new practice, even if you don’t have everything that will be required for your credentials in order, time is of the essence. Please contact us to discuss the contracting and credentialing process several months in advance of your anticipated start date. We would be happy to guide you in the process so you can get paid for the patients you see on your first day in the office.

What We Do...

Physicians’ Ally, Inc. provides credentialing services primarily for contract negotiation clients since credentialing is necessary to maintain the contracts. We do consider other credentialing projects and recommend that you call and speak with us directly to discuss specific needs related to your group.

For example, this would include maintaining online credentialing databases (NPPES, CAQH, PECOS), acquiring or maintaining hospital privileges, maintaining government payor regulatory re-validations, onboarding new providers, updating contracted health plans, as necessary, and miscellaneous demographic updates. Services are billed monthly at an hourly rate according to our standard Consulting Agreement.

How to get Started...

Getting started is easy and requires the execution of our standard Consulting Agreement, and providing Physicians’ Ally, Inc. with the requested data. Physicians’ Ally, Inc. provides each credentialing client with a ‘scavenger hunt’ checklist of required credentialing items for the specific specialty or type of practice. If a physician is already enrolled in the online Council for Affordable Quality Healthcare (CAQH), Universal Provider Datasource® (UCD), database, this often provides most of the necessary information.