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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.
Our Credentialing Process
Our Rigorous Provider Credentialing Process, Vetted by Specialists
UMBS, our provider credentialing process ensures top-tier compliance and success. With up to a 98% approval rate in premium payer networks, we guarantee maximum privileges in specialties. Steps include:
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.
Payer Enrollment & Credentialing for Doctors
Credentialing & Payer Enrollment for Healthcare
Essential for quality care, compliance, and patient attraction, proper credentialing is vital for healthcare providers. Our comprehensive service aids providers of all specialties. Payer enrollment credentialing services cover:
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.
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
Identifying & Eliminating
Credentialing Challenges
We acknowledge the hurdles faced by behavioral healthcare professionals in obtaining credentials and are committed to identifying and addressing these challenges. We understand that one significant reason for credentialing delays is the variance in processes across states and countries. To tackle this issue, we’ve developed a thorough understanding of credentialing requirements in different jurisdictions, enabling us to navigate these differences efficiently and streamline the process for our clients.
Another challenge applicants encounter is the frequency of the credentialing process, which can be demanding and disruptive for physicians. Recognizing the importance of timely and efficient credentialing, we ensure that all necessary documentation is acquired and completed within the required timeframes.
At Hansei Solutions, our expertise and meticulous approach are dedicated to delivering a seamless and efficient credentialing experience for behavioral healthcare professionals. We aim to alleviate their challenges, allowing them to focus on delivering quality care to their patients.
