Credentialing Services for Healthcare Providers
Join Our Satisfied Practitioners with Our Doctor Credentialing and Enrollment Services.
UMBS Credentialing Services
Accelerate Your Access to Premium Payer Networks!
Credentialing, often referred to as insurance credentialing or doctor credentialing, is a crucial process that verifies the qualifications, expertise, and legitimacy of healthcare providers. At the Foreign Credentials Service of America, we specialize in ensuring that healthcare professionals meet the necessary standards for practice.
Credentialing confirms that providers hold the essential licenses, certifications, and educational qualifications required for delivering high-quality healthcare services. Only credentialed providers are eligible for payments from payers and compliance with state and federal regulations.
Foreign Credential Services of America supports medical credentialing, helping physicians gain access to essential insurance networks like CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield. Rapid credentialing is essential for providers to start practicing and billing promptly, ensuring compliance with legal and ethical standards.
However, credentialing is a complex process involving thorough documentation and verification across various stages by insurance networks. A single error can lead to claim denials, wasting valuable resources like time and finances.
We advocate for providers to secure valuable in-network contracts
Our Rigorous Provider Credentialing Process, Vetted by Specialists
Our provider credentialing process at UMBS is designed to ensure compliance and success, giving you maximum privileges in your specialty.
Our Steps Include:
Provider Assessment
We begin with a thorough assessment, collecting vital data through in-depth interviews, including license numbers, education, demographics, and professional history.
Selecting the insurer
We assist providers in choosing compatible insurance partners that align with their practice goals and license type. We finalize insurance panels based on your practice location.
CAQH Enrollment & Management
We handle CAQH applications, manage ProView accounts, and keep credentials current for seamless verification. Our team also aids in payer credentialing submissions to ensure swift insurance panel inclusion.
Rapid Credentialing Approval
While typical timelines range from 60-120 days, our experts work diligently to expedite the process. We engage with payers weekly to advocate for swift processing of your applications.
In-Network Enrollment
After credentialing, we manage your application through the contract phase. We navigate challenges with closed panels, advocating for your inclusion through appeals. Successful credentialing allows for direct billing, often at preferred reimbursement rates.
Securing Your Hospital Privileges
Our support continues even after credentialing is complete. We help secure all necessary hospital privileges, from admitting to surgical rights.
Monitoring and Updates
We provide ongoing oversight to keep your credentials current and active. Our experts monitor expirations and conduct regular reviews, ensuring your status remains uninterrupted.
"Get credentialed and enrolled 2x faster"
Payer Enrollment & Credentialing for Doctors
Credentialing & Payer Enrollment for Healthcare
Physicians
Our service fast-tracks physician access to insurance networks, enhancing patient care. Vital for credibility and trust among patients and peers.
PAs/NPs
Our service expands PAs/NPs practice reach, authorizing independent delivery of essential medical services.
Hospitals
Optimize hospital operations with our streamlined credentialing, facilitating efficient insurance processing and fostering staff collaboration.
PT/OT/SLP
Our credentialing ensures therapists join insurance panels, providing crucial rehabilitation services while ensuring financial stability
Podiatrists (DPM)
Empower podiatrists with our credentialing, establishing them as recognized experts in specialized foot care.
Chiropractors (DC)
Solidify chiropractors' standing with our credentialing, granting access to insurance networks for broad patient engagement.
Ambulatory Surgery Centers (ASC)
Our ASC credentialing service boosts patient trust by showcasing adherence to rigorous quality standards, vital for safe surgical procedures.
Urgent Care Facilities
Our credentialing ensures urgent care facilities are in-network with insurers, expanding access to prompt and affordable medical services for a broader patient base.
Diagnostic Testing Facilities
Credentialing secures insurance approval for diagnostic facilities and labs, boosting patient referrals and facilitating prompt diagnosis and treatment.
Optometrists, Audiologists
Credentialing expands optometrists' and audiologists' reach, delivering essential eye and ear care services to diverse clientele.
Behavioral Health Providers
Our credentialing service helps behavioral health providers join insurance networks, extending vital mental health services to those in need.
Start up practice Special Offer
Identifying & Eliminating
Credentialing Challenges
We understand the unique challenges behavioral healthcare professionals face in obtaining credentials. Our expertise in the credentialing requirements across different states and countries allows us to efficiently navigate variations in processes. We prioritize timely credentialing by ensuring all necessary documentation is collected and completed within the required timeframes.
Comprehensive Payer Assistance
Enroll with Your Preferred Payer via UMBS
Government Payers
Examples include – Medicare, Medicaid, and TRICARE.
Commercial Payers
Examples include – Blue Cross Blue Shield, Kaiser Permanente, Anthem, United Healthcare, Aetna, Cigna, and Humana
The required documents can vary depending on the insurance plan and the type of physician or practitioner. Below is a list of commonly needed documents:
Documents for Individuals:
- Practitioner License(s)
- Malpractice Insurance (Certificate of Insurance)
- DEA (federal) and state CDS certificates
- Board Certification(s)
- Diploma – copy of highest level of education (required for non-MDs, DOs)
- Current CV (showing current employer, with all entries in mm/yy format)
- Current driver’s license
Additional Necessary Documents:
- ECFMG Certificate (if educated outside the United States)
- Passport or other citizenship documents (if born outside the U.S. and not previously enrolled in Medicare)
- Collaborative Agreement (required for Nurse Practitioners)
- Admitting Arrangement letter (required for providers who do not have hospital admitting privileges)
- Prescribing arrangement letter (for providers not holding a DEA certificate)
Documents Needed for Your Legal Entity:
- IRS form CP575 or replacement letter 147C (verification of EIN)
- CLIA Certificate
- Business License
- Copy of office lease (required for therapy facilities)
- Letter of bank account verification (for Medicare enrollment)
- IRS Form W-9
The turnaround time for credentialing varies by insurance carrier, so there is no definitive answer. Major carriers typically take 90-120 days to complete the process, while smaller carriers and plans may take longer.
When a provider submits a participation request to a commercial carrier, they must undergo two processes. The first is credentialing, where the carrier verifies all submitted credentials and presents them to their committee for approval. Once approved, the provider moves to the contracting process, where their participation is confirmed, and they receive their effective date.
It's important to note that commercial carriers do not permit retroactive billing. Providers will only be compensated for claims submitted after they are listed as "In-Network" in the carrier's claims system. Billing out of network can lead to significantly higher bills for patients, who may be responsible for covering the entire cost independently.
Medicare enrollment applications typically take between 60-90 days to process, though this can vary significantly between states. The effective date for Medicare is set as the date the application was received, allowing providers to retroactively bill for services rendered from the application date to the approval date. Additionally, there is a 30-day grace period that permits providers to bill for services provided up to 30 days before their effective date.
For DMEPOS suppliers, the process takes longer. Applications undergo thorough scrutiny, including a mandatory site visit. During the site visit, inspectors verify the office location, hours of operation, inventory storage, and other critical aspects of being a DME supplier.
Providers must have a service location before starting the medical credentialing and contracting process. A home address cannot be used as a clinic address, either permanently or temporarily. However, it can be used for billing or correspondence if a physical practice address is provided. If the office space is still under construction, the address can still be used. Applications can be sent up to 30 days before the location opens to patients, a guideline often followed by commercial carriers as well.
