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Physician Medical Credentialing Services

Credentialing is a complex process that requires a lot of documentation and verification to become part of an insurance network. A simple error or missing form can delay enrollment and result in a significant loss of revenue by making that network’s patients inaccessible to you.

Radiant RCM stands out as the premier provider of medical credentialing services in the US. We simplify the process so that you can focus on your core mission. Our experts handle credentialing tasks efficiently, from primary source verification to premium network enrollment.

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Our Comprehensive Medical Credentialing Services 

Since 2012, Radiant RCM has helped healthcare providers accelerate credentialing and enrollment. Our proven 95% success rate ensures your process is completed efficiently, saving you valuable time and minimizing administrative burdens. We offer a comprehensive suite of physician medical credentialing services designed to meet the needs of specialties of all sizes.

MCR DMEPOS Enrollment

Medicare Carrier Request, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (MCR DMEPOS) enrollment is the process required by Medicare to be allowed to provide these specific products and services and bill Medicare for them. Our physician credentialing services help you enroll in the Medicare DMEPOS program, so that you can improve the quality of care and receive reimbursement from Medicare.

Commercial
Insurance Credentialing

The medical credentialing process with commercial insurance payers can be lengthy due to varying eligibility criteria and plan complexities. The process can take several months before you can start seeing their patients, so we make sure there are no additional delays due to missing information. Our expert team gathers and organizes all required documentation, including licenses, certifications, and training records. We ensure you get credentialed with commercial insurance payers like Humana, Cigna, and Aetna.

Revalidation
& Re-Credentialing

Revalidation and re-credentialing are required over time to ensure continuous compliance and active status with payers. Usually, validation is required every five years, and re-credentialing is required every three years. Our physician credentialing services offer a smooth revalidation process with Medicare, Medicaid, and commercial insurers. We proactively update your demographics (practice location, contact information, etc.) to prevent any delays or penalties.

CAQH Registration and Maintenance

Our credentialing specialists register and maintain your provider’s profile on the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView). This streamlines the medical credentialing process with multiple health plans.

Medicare and Medicaid Provider Enrollment

We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. This leads to a wider patient base and, potentially, a lot more revenue for their practices.

NPI Registration (Type 1 and Type 2)

Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.

Hospital Privileges

We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice. 

Contract Negotiation

Negotiation is required with each insurance payer to get the most favorable terms and maximum reimbursement rates. Our experienced credentialing team helps physicians negotiate contracts with insurers to get the most favorable terms for their services, payment rates, and network inclusion.

Reimbursement Issues Audit

We conduct thorough audits of reimbursement processes to identify and resolve issues that may be affecting your revenue cycle. These issues include claim denials, underpayments, delays, or errors by insurance payers. Our goal is to optimize your reimbursement rate while minimizing potential revenue losses.

Provider State Licenses

We assist providers in obtaining and renewing state medical licenses. The rules and regulations for issuing licenses to healthcare providers differ by state. Obtaining and renewing state licenses can benefit providers in three ways: compliance, competence, and liability protection.

DEA Certificate & Renewal

All qualified practitioners who write controlled substance prescriptions must hold a federal Drug Enforcement Administration (DEA) certificate. Our healthcare credentialing services include the application and renewal processes for DEA certificates. We enable healthcare providers to prescribe and handle controlled substances according to their specialty.

CLIA Registration

Practitioners and laboratories that perform tests for disease diagnosis, prevention, or treatment must be registered in accordance with the Clinical Laboratory Improvement Amendments (CLIA). We assist healthcare providers with the CLIA registration process, enabling them to provide testing services to patients.

Benefits of Outsourcing Medical Credentialing Services to Radiant RCM 

Aggressive Follow-Up

Most insurance plans have a backlog of credentialing applications. Radiant RCM makes sure that your application gets received. We check regularly to see where it is in the process. Our dedicated team maintains a record of all ongoing follow-ups until the application is approved and participation is confirmed.

Expert Application Completion

Application errors may result in delays and denials. Our diligent team ensures your application is complete and gets approved the first time it is submitted. We carefully submit your practice address, license, fax, contact information, services provided, and any other records of experience to prevent delays or denials.

Compliance with NCQA

Our physician credentialing services comply with the National Committee for Quality Assurance (NCQA) standards. This provides our clients access to preferred partnerships and networks, ultimately expanding your patient base.

Continuous CAQH Monitoring

CAQH requires maintaining up-to-date credentialing information and regularly re-attesting the information in CAQH profiles. When we receive updated insurance, license, or DEA documents from you, our skilled team uploads the new data to CAQH with an updated expiration date. Keeping your records updated prevents re-accreditation delays.

A Walkthrough of Our Credentialing Process

Our credentialing process usually includes the following four steps:
Gather Your Documents

We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements

Verification and Notification

We will verify your credentials with the issuing bodies. Our expert team will double-check everything with the official sources. Once everything is in order, we will assist you in obtaining approval from hospitals and insurance companies.

Onboarding

Contact Radiant RCM to discuss the details of your organization and health plans for enrollment.

Submit Your Applications

Our team will complete the appropriate applications and submit them to your preferred payers

Onboarding

Contact Radiant RCM to discuss the details of your organization and health plans for enrollment.

Gather Your Documents

We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements.

Submit Your Applications

Our team will complete the appropriate applications and submit them to your preferred payers.

Verification and Notification

We will verify your credentials with the issuing bodies. Our expert team will double-check everything with the official sources. Once everything is in order, we will assist you in obtaining approval from hospitals and insurance companies.

Our Credentialing Services Benefit All Kinds of Practitioners

Hospitals

Clinical Social Workers

Registered Nurses

Podiatrists

PAs/NPs

Physical Therapists

Optometrists

PT/OT/SLP

Clinical Psychologists

Physicians

Podiatrists (DPM)

Occupational Therapists

Marriage and Family Therapists

Dentists

Speech-Language Pathologists

Chiropractors (DC)

Dentists

And many more

Frequently Asked Questions

The necessary documents vary depending on the insurance plan and the type of physician/practitioner. The following is a list of some fundamental documents that are typically needed:

Personal documents:

  • Current CV (including current employer, with all entries in mm/yy format)
  • DEA (federal) and state Controlled Dangerous Substances (CDS) certificates
  • Malpractice Insurance (Certificate of Insurance)
  • Current driver’s license
  • Board Certification(s)
  • Practitioner License(s)
  • Diploma or a copy of the highest level of education (required for non-MDs and DOs)

Additional required documents:

  • Collaborative Agreement (required for Nurse Practitioners)
  • ECFMG Certificate (if the provider was educated outside the US)
  • Letter of Admitting Arrangement (required for providers who do not have hospital admitting privileges)
  • Passport or other citizenship documents (if the provider was born outside the United States and has not previously enrolled with Medicare)
  • Letter of Prescribing Arrangement for a physician who does not hold a DEA certificate.

Documents required for your legal entity:

  • IRS Form CP575 or substitute letter 147C (EIN verification)
  • IRS Form W-9
  • CLIA Certificate
  • Copy of office lease (required for therapy facilities)
  • Business License
  • Verification letter of bank account (for Medicare enrollment)
 

Medicare enrollment for regular providers takes 2-3 months but allows retroactive billing. Note that this period can vary from state to state. For DMEPOS suppliers, expect a longer wait due to stricter confirmation, including a site visit.

CP575 is an IRS notice that confirms your business’s Employer Identification Number (EIN). It’s basically a confirmation letter saying your business tax ID application was successful.

This letter serves as additional verification of the business’s legal name and must be submitted with the Medicare enrollment application. If the original is unavailable, a replacement letter (147C) can be requested as proof of the EIN. Medicare accepts only these two documents as proof of the EIN.

The specific Medicare application used for provider enrollment depends on the type of provider enrolling. Here’s a breakdown:

  • Physicians and Non-Physician Practitioners: CMS-855I
  • Group Practices, Clinics, and Certain Other Suppliers: CMS-855B
  • Institutional Providers: CMS-855A
  • Ordering and Certifying Physicians and Non-Physician Practitioners: CMS-855O
  • DMEPOS Suppliers: CMS-855S (This form might be undergoing revisions)

You can find these forms and more information on the official CMS website: 

https://www.cms.gov/ 

In most cases, yes, providers must have a service location to begin credentialing for Medicare. Providers cannot use their home address as a clinic address, either permanently or temporarily.

While some exceptions might exist, a home address can be used for billing and correspondence, as long as a physical business address is also provided. This works even if the office is still under construction. The application can be submitted up to 30 days before the location opens for patients. Most commercial carriers have the same policies.

Radiant RCM Is Your Trusted Partner In Credentialing & Enrollment

Are you ready to experience a streamlined and efficient credentialing process? Partner with Radiant RCM and let our expert team provide you with smooth and efficient physician credentialing services.
We guarantee to accelerate the credentialing process, submit clean claims, and maximize your revenue potential by up to 30%.

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