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2X Faster and Easier!
Join Our Satisfied Practitioners with Our Doctor Credentialing and Enrollment Services.
UMBS Credentialing Services
Join Premium Payer Networks Faster Than Ever Before!
Credentialing, whether referred to as insurance credentialing or doctor credentialing, stands as the vital process that confirms the qualifications, expertise, and legitimacy of healthcare providers. It’s the cornerstone ensuring that providers possess the essential licenses, certifications, and educational background requisite for delivering healthcare services to patients.
Eligibility for payments from payers and adherence to state and federal regulations are reserved solely for credentialed providers. Medical credentialing empowers physicians to practice within specific facilities and gain inclusion in pivotal insurance networks such as CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield.
For providers, the need for rapid credentialing is paramount for prompt commencement of practice and billing, within the bounds of legality and ethics. However, credentialing is a multifaceted process entailing meticulous documentation and verification across various stages by insurance networks. A single error could lead to denials, squandering valuable resources such as time and finances.
"We advocate for providers to secure valuable in-network contracts"
Our Rigorous Provider Credentialing Process, Vetted by Specialists
Provider Assessment
We kick off our credentialing process with thorough surveys led by our specialists. We collect vital data through in-depth interviews including license numbers, education, demographics, and professional history.
Selecting the insurer
We assist providers in selecting compatible insurance partners aligned with their practice goals and license type. Additionally, we finalize insurance panels based on practice location.
CAQH Enrollment & Management
We handle CAQH applications, manage ProView accounts, and maintain current credentials for seamless verification. Additionally, we aid in payer credentialing submissions for swift insurance panel inclusion, ensuring accurate profiles that boost network engagement and patient care quality.
Rapid Credentialing Approval
While the usual timeline is 60-120 days, our experts proactively expedite the process. We interact weekly with payers, advocating for swift processing and endorsement of your applications.
In-Network Enrollment
After credentialing, your application proceeds to the contract phase. We manage closed panel challenges, advocating for your inclusion through appeals. Successful credentialing enables direct billing, often with preferred reimbursement rates.
Securing Your Hospital Privileges
Even as credentialing concludes, our support continues. We help secure all essential hospital privileges, from admitting to surgical rights.
Monitoring and Updates
We provide ongoing oversight to keep your credentials up-to-date and uninterrupted. Our experts monitor expirations and conduct regular reviews, ensuring your active status. Trust us to manage your credentials reliably.
"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 recognize the challenges behavioral healthcare professionals face in obtaining credentials and are dedicated to identifying and overcoming these obstacles. Understanding that variations in processes across states and countries are a major cause of credentialing delays, we have developed a comprehensive knowledge of credentialing requirements in different jurisdictions. This expertise enables us to navigate these differences efficiently and streamline the process for our clients.
Another significant challenge is the demanding and disruptive nature of frequent credentialing processes for physicians. We prioritize timely and efficient credentialing by ensuring all necessary documentation is obtained and completed within 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.
