Medical Credentialing Services
MedEx MBS is a top-rated Medical Credentialing Service Provider. Our Outsourced Credentialing Services eliminate administrative burdens while also unlocking privileges, ensuring in-network integration, and accelerating reimbursements. Our Provider Credentialing Company has empowered doctors, nurses, and therapists to thrive in their careers. Join the ranks of satisfied practitioners via our Doctor Credentialing and Enrollment Services.
We champion a provider's access to prized in-network contracts...
MedEx provider enrollment services unlock in-network contracts, no matter how exclusive the payor panel.
Advocacy for healthcare providers
Collaborate with insurance companies
Secure your place in premium networks
Maximum hospital privileges
MedEx Provider Credentialing Services
We Enroll Providers In Premium Payer Networks In Record Time!
Credentialing, also known as insurance credentialing or doctor credentialing, is a process that verifies the qualifications, skills, and legitimacy of healthcare providers. This process ensures that the provider has the necessary licenses, certifications, and education to provide healthcare services to patients.
Only a credentialing provider can receive payments from the payer and work in compliance with the state and federal regulations. Medical credentialing authorizes physicians to practice in a specific facility and be included in insurance networks like CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield.
As a provider, you want fast credentialing so as to start practicing and billing (legally and ethically). But credentialing is a complex process that involves a lot of documentation and verification at different stages by the insurance network. This means a single mistake can result in denials and wastage of resources such as time and money.
Our Medical Credentialing Process
A Walkthrough of Our Specialist-Vetted Provider Credentialing Process
MedEx’s provider credentialing process is not just a routine procedure, but a validated and certified process that ensures the highest compliance standards. We have achieved up to a 98% success rate in 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.
Complete Provider Credentialing Solutions
Helping Health Care Providers With All Their Credentialing Needs
MedEx credentialing company offers all-inclusive provider credentialing services for healthcare professionals and organizations. Here’s an overview of the medical credentialing and enrollment services we provide:
Medicare and Medicaid Provider Enrollment
We enroll providers in Medicare and Medicaid programs, which are the largest health insurance programs in the US, covering millions of Americans. By enrolling in these programs, providers can expand their patient base, increase their revenue, and comply with federal and state regulations.
Commercial Insurance Credentialing
We credential providers with commercial insurance payers like Aetna and Humana, which are private health insurers that offer different plans and networks for their members. By credentialing with these companies, providers can access more patients and negotiate better reimbursement rates.
NPI Registration (Type 1 and Type 2)
Our credentialing solutions help individual providers (Type 1) and organizations (Type 2) with obtaining and updating their National Provider Identifier (NPI), which is a unique 10-digit identification number assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS). Having an NPI is required for billing, reporting, and electronic transactions.
CAQH Registration and Maintenance
We help providers stand head and shoulders above their peers. Our credentialing specialists register and maintain every provider’s profile on the Council for Affordable Quality Healthcare (CAQH) ProView, which is an online database that collects and verifies provider information for credentialing purposes. By using CAQH ProView, providers can refine their credentialing process with multiple health plans.
MCR DMEPOS Enrollment
Providers using our credentialing service can enroll in the Medicare DMEPOS program, which covers items such as wheelchairs, oxygen equipment, braces, and diabetic supplies. By enrolling in this program, providers can offer these items to Medicare beneficiaries, improve their quality of care, and receive reimbursement from Medicare.
Hospital Privileges
We facilitate physicians with obtaining and renewing their hospital privileges, which are the rights and responsibilities granted by a hospital to a provider to practice within its facilities. By having hospital privileges, providers can admit and treat patients, access hospital resources, and collaborate with other health care professionals
Contract Negotiation
Our credentialing team provides support to the doctors with negotiating contracts with insurance payers, which are the agreements that define the terms and conditions of the provider-payer relationship. By negotiating contracts, medical practitioners can secure favorable payment rates, dispute resolution processes, quality measures, and network inclusion.
Revalidation & Re-Credentialing
Our medical insurance credentialing service manages every physician’s revalidating and re-credentialing enrollment process and credentialing status with Medicare, Medicaid, and commercial insurers. With MedEx managing these processes on autopilot, providers can maintain their eligibility to participate in these programs and avoid any interruptions or penalties.
Reimbursement Issues Audit
Our credentialing and privileging specialists audit reimbursement issues, such as underpayments, denials, delays, or errors from insurance payers. Providers also get accounts receivable (AR) follow-up services to help collect outstanding payments from payers. By auditing reimbursement issues and following up on AR, providers can improve their cash flow, reduce their bad debt, and optimize their revenue cycle.
