Credentialing smart-admin August 23, 2024

Medical Credentialing Services
Get Credentialed & Enrolled. 2X Faster and Easier!

Smart Health is a leading provider of Medical Credentialing Services. Our outsourced credentialing services reduce administrative hassles, help secure privileges, ensure in-network participation, and speed up reimbursements. Our provider credentialing services have helped doctors, nurses, and therapists succeed in their careers. Join the many satisfied practitioners through our doctor credentialing and enrollment services.

Why Choose Us?

Smart Health Medical Coding Protects You from Major Risks

Credentialing, also known as doctor or insurance credentialing, verifies the qualifications, licenses, and certifications of healthcare providers. This process ensures providers can legally practice and receive payments from insurance networks like Medicare, Medicaid, and private insurers.

Quick credentialing is crucial for providers to start billing legally, but the process is complex and requires careful documentation. Mistakes can lead to denials and wasted time. Smart Health offers efficient credentialing solutions, handling everything from verification to insurance network enrollment, saving you time and money.

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How Does Smart Health's Credentialing Help?

1st Class Reimbursements
Enjoy the advantage of first-preference reimbursement rates, maximizing your financial rewards. This means you get paid more for the same services, increasing your profitability and satisfaction.
Payer Support & Privileges
Our advocacy ensures insurance companies stand by you, supporting your needs. We negotiate on your behalf and resolve any issues that may arise, ensuring you get paid fairly and promptly.
Minimize Denials & Rejections
With our expertise, denials become a thing of the past, boosting your efficiency. We verify eligibility, obtain authorizations and submit accurate claims, reducing errors and rejections. Smart Health always looks for you.
Complete Provider Credentialing Solutions
Get advanced help with Credentialing
Smart Health offers comprehensive provider credentialing services for healthcare professionals and organizations. Below is an overview of the medical credentialing and enrollment services we provide:

Contract Negotiation, Revalidation and Reimbursement Audits

Our credentialing team assists doctors in negotiating contracts with insurance payers, securing better payment rates, dispute resolution processes, and network inclusion. We also manage the revalidation and re-credentialing process with Medicare, Medicaid, and commercial insurers, ensuring providers maintain eligibility and avoid interruptions. Additionally, our specialists audit reimbursement issues, including underpayments and denials, and provide accounts receivable follow-up services, helping providers improve cash flow and optimize their revenue cycle.

Comprehensive Provider Enrollment and Credentialing Services

We offer enrollment services for Medicare and Medicaid, the largest health insurance programs in the U.S., allowing providers to expand their patient base, boost revenue, and stay compliant with regulations. Additionally, we credential providers with commercial insurers like Aetna and Humana, enabling access to more patients and better reimbursement rates. Our solutions also include assisting individual providers (Type 1) and organizations (Type 2) in obtaining and updating their National Provider Identifier (NPI), essential for billing and electronic transactions.

CAQH Registration, MCR DMEPOS Enrollment, and Hospital Privileges

Our credentialing specialists ensure providers stand out by managing their profiles on the CAQH ProView, an online database that streamlines credentialing with multiple health plans. We also assist providers in enrolling in the Medicare DMEPOS program, allowing them to supply essential items like wheelchairs and diabetic supplies to Medicare beneficiaries while receiving reimbursements. Additionally, we help physicians obtain and renew hospital privileges, enabling them to admit and treat patients, access hospital resources, and collaborate with other healthcare professionals.

Complete Payer Support
Enroll With Your Favorite Payer Through Smart Health

Government Payers

Examples include – Medicare, Medicaid and TRICARE.

Commercial Payers

Examples include – Blue Cross Blue Shield, Anthem, United Healthcare, Aetna, Cigna and Humana.

Get credentialing done right with our proven process.

01.

Our credentialing process begins with an in-depth survey conducted by our credentialing specialists.

02.

Our medical credentialing services guide providers in strategically choosing insurance partners.

03.

We take care of CAQH application submissions, manage ProView accounts, and keep credentials current for smooth primary source verification.

04.

Although the typical timeline is 60-120 days, our provider credentialing experts take proactive steps to accelerate the process.

05.

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.

06.

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.

07.

Our continuous oversight ensures that your company’s credentials remain current and that you stay credentialed without interruption.