Our Medical Credentialing Process
A Walkthrough of Our Specialist-Vetted Provider Credentialing Process
Urgent RCM’s provider credentialing process is not just a routine procedure, but a validated and certified process that ensures the highest standards of compliance. We have achieved up to 98% success rate of getting providers approved in premium payer networks with maximum privileges in their specific specialties. The process typically includes the following steps:
Surveying the provider
Our credentialing process begins with an in-depth survey conducted by our credentialing specialists. This process involves comprehensive interviews with providers, gathering essential data such as license numbers, educational history, demographics, and professional background.
Choosing the insurance company
Our medical credentialing services guide providers in strategically choosing insurance partners aligned with their practice goals and license type, while also finalizing insurance panels based on practice location.
CAQH Enrollment and Management
We take care of CAQH application submissions, manage ProView accounts, and keep credentials current for smooth primary source verification. We also assist with payer credentialing submissions, ensuring quick insurance panel integration and accurate profiles that enhance network engagement and the quality of patient care.
Ensure Fast Credentialing Approval
Although the typical timeline is 60-120 days, our provider credentialing experts take proactive steps to accelerate the process. Our team engages in weekly interactions with payers, advocating for the rapid processing and endorsement of your credentialing applications.
In-Network Enrollment
Upon completing credentialing, your application enters the contract phase. Here, an in-network contract may be offered, including fee schedules and eligible CPT billing codes. We handle closed panel challenges, advocating through appeals to secure your inclusion. With successful credentialing, direct billing becomes feasible, often with preferred reimbursement rates for in-network providers.
Winning you Hospital Privileges Application
As credentialing wraps up, our active involvement persists. We assist you in gaining all necessary hospital privileges: whether it’s admitting, courtesy, or surgical rights.
Ongoing Monitoring and Updates
Our continuous oversight ensures that your company’s credentials remain current and that you stay credentialed without interruption. Our experts diligently track your credentialing expirations and conduct comprehensive daily and weekly reviews to maintain your active status. You can rest easy knowing that your credentials are in good hands with us.
