Credentialing and Re-credentialing ? Offshore Outsourcing is the solution!

Posted by Deepak Sanghi on February 4th, 2016

Physician credentialing and re-credentialing contributes a great deal to the revenue cycle management of a Practice. Even if Providers render exceptional medical billing services, Payers reimburse only if they are properly credentialed. That is the reason why healthcare Providers have to pay extra attention to provider credentialing and re-credentialing processes. Getting credentialed and re-credentialed as per the requirements of each Payer may be a painstaking task. Providers will find these processes challenging while they already have too much on their plates like the ICD-10 implementation, software & technology upgradation, and staff training. Let us discuss the problems and arrive at a possible solution:

Payer to Payer Differences: The timeline and rule set for credentialing and re-credentialing processes vary from one Payer to another. For instance, a Provider may have enrolled with one or more payers. He will have the necessity of getting credentialed and re-credentialed based on the requirements and timelines predetermined by each Payer. The bitter fact is that healthcare entities lack employees with the right skillset to perform physician credentialing and re-credentialing.

Providers’ Varied Requirements: Provider credentialing and re-credentialing processes vary from Provider to Provider based on their diverse needs.

• If it is the first time for a Provider to get credentialed, then the normal rule set applies.

• In case, a Provider is starting a new practice, then he cannot use the old contracts of the Payers he has already been credentialed with. New Provider credentialing contracts should be signed with each Payer. Same rule applies if the Provider relocates from one state to another.

• When we consider large healthcare practices, Payers may sign group contracts with them. If more Providers are added to a practice, then each Provider will have to get credentialed with either the group contract or with the Payer individually. In the latter case, the Payer will send the Provider’s reimbursements to the practice’s tax ID.  

• The physician credentialing process must be carried out from the first, if a Provider is changing from one Practice to another. The same rule applies if a Provider needs to enroll with a new Payer.

Solution: As mentioned earlier, performing physician credentialing and re-credentialing processes without help can be a herculean task. Therefore, the prudent solution would be to outsource these services to a reputed offshore medical billing company like e-care. e-care has been providing competent physician credentialing and re-credentialing services to its clients for more than 10 years.

Tip from e-care: For Providers who are out of medical school and are confused on which Payer to credential with, e-care offers the best services. It helps the Providers to enroll with the top commercial Payers like Aetna, BCBS, Cigna, Coventry, Humana, Multiplan, UHC, and Wellcare, in addition to Medicare, Tricare and Medicaid.

About e-care India:
e-care India has 16 years of experience in the industry. e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical billing services, physician credentialing and re-credentialing services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com.