Medical Credentialing Services
At RPM Medical Billing, we understand that proper credentialing is essential for healthcare providers to deliver exceptional care while maximizing financial success.
Our credentialing services streamline the process, allowing you to focus on what matters most, your patients.
Why Choose RPM Medical Billing for Credentialing?
- Accelerated Credentialing Process: Get credentialed and enrolled efficiently, enabling you to start billing and receiving reimbursements sooner.
- Customized Solutions: We cater to practices of all sizes and specialties, tailoring services to meet your unique needs.
- Expert Advocacy: Our team manages every step, from applications to payer negotiations, ensuring you secure favorable contracts and maximize privileges.
- Real-Time Data Access: Access up-to-date information in your billing system without delays.
- Comprehensive Support: We ensure your credentials remain current and compliant from initial enrollment to ongoing maintenance.
We Help Providers Join Premium Payer Networks Faster!
Credentialing, often called provider credentialing or insurance credentialing, is a critical process that verifies a healthcare provider’s qualifications, skills, and legitimacy. It ensures that providers meet all requirements, such as holding valid licenses, certifications, and educational credentials, to deliver patient care.
Proper credentialing authorizes providers to practice in specific facilities and secures their inclusion in major insurance networks like CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield.
Without credentialing, healthcare providers cannot legally bill payers or operate in compliance with state and federal regulations. Timely and accurate credentialing is essential to begin practicing and billing efficiently. However, the process can be time-consuming, requiring meticulous documentation and verification at every stage. Even minor mistakes can lead to costly delays, denials, or rejections.
At RPM Medical Billing, we specialize in simplifying and accelerating credentialing. From primary source verification to enrollment in payer networks, our expert team precisely manages every step. We deliver efficient, reliable credentialing solutions to get you credentialed, enrolled, and ready to bill legally, ethically, and without unnecessary delays.
Why Choose RPM Medical Billing for Audits?
Our Credentialing Services Process
At RPM Medical Billing, we offer end-to-end credentialing solutions designed to ensure compliance, maximize reimbursement potential, and streamline your practice operations.
Step 1: Provider Enrollment
We handle the complexities of provider enrollment to ensure you are credentialed and enrolled with government and commercial payers.
Step 2: Primary Source Verification
Our team conducts thorough primary source verification to ensure compliance with payer and regulatory requirements.
Step 3: CAQH Registration and Maintenance
We manage your Council for Affordable Quality Healthcare (CAQH) profile to streamline your credentialing process.
Step 4: Hospital Privileges Assistance
We facilitate obtaining and renewing hospital privileges, enabling you to provide care in hospital settings.
Step 5: Contract Negotiation
We advocate for securing the most favorable contract terms with payers.
Step 6: Re-Credentialing and Ongoing Monitoring
Credentialing is an ongoing process, and we provide continuous support to keep you compliant.
Complete Credentialing Solutions by RPM Medical Billing
Helping Healthcare Providers Meet All Their Credentialing Needs
RPM Medical Billing offers all-inclusive credentialing services to streamline enrollment and compliance for healthcare professionals and organizations.
Medicare and Medicaid Provider Enrollment
We simplify enrollment in Medicare and Medicaid, the most extensive insurance programs in the U.S. By joining these networks, providers can:
- Expand their patient base.
- Increase revenue opportunities.
- Ensure compliance with federal and state regulations.
Commercial Insurance Credentialing
Our credentialing specialists help providers secure contracts with major commercial insurers, such as Aetna, Humana, and Blue Cross Blue Shield. Benefits include:
- Access to a broader patient population.
- Improved negotiation power for favorable reimbursement rates.
NPI Registration (Type 1 and Type 2)
RPM assists with obtaining and updating National Provider Identifier (NPI) numbers for individual providers (Type 1) and organizations (Type 2). This unique identifier is essential for:
- Billing and claims submission.
- Electronic health transactions.
- Reporting and compliance with CMS requirements.
CAQH Registration and Maintenance
We manage your Council for Affordable Quality Healthcare (CAQH) ProView profile, ensuring seamless integration into multiple health plans. Services include:
- Initial registration and profile setup.
- Regular updates to maintain accuracy and compliance.
- Optimizing profiles for faster insurance panel approvals.
MCR DMEPOS Enrollment
For providers offering durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), RPM facilitates enrollment in Medicare’s DMEPOS program. This service helps:
- Expand your offerings to Medicare beneficiaries.
- Improve patient care quality.
- Ensure proper reimbursement for covered items.
Revalidation and Re-Credentialing
Credentialing is an ongoing process, and RPM ensures you remain compliant by:
- Managing expiration dates and revalidation deadlines.
- Submitting updated applications for continued payer participation.
- Preventing disruptions in reimbursements or compliance issues.
Reimbursement Audits and AR Follow-Up
Our team audits reimbursement issues, such as denials, delays, or underpayments, and provides accounts receivable (AR) follow-up services to:
- Recover outstanding payments.
- Improve cash flow and reduce bad debt.
- Optimize your revenue cycle.
Partner with RPM Medical Billing for Seamless Credentialing
Let RPM Medical Billing take the hassle out of credentialing. From Medicare and Medicaid enrollment to commercial insurance contracts, we manage every detail, allowing you to focus on providing exceptional patient care.
Contact RPM Medical Billing at 855-577-6633 to learn more about our credentialing solutions and maximize your practice’s potential today.
