Provider Enrollment and Credentialing Services

Our Provider Enrollment and Credentialing Services Process

1) Initial provider information collection

• Provider personal information such as full name, contact details, medical license details, social security number (SSN).
• Licensure information that includes provider’s medical, nursing or other relevant licenses, its expiration dates, numbers, and states where they are licensed.
• Provider’s education history, including details about medical school, postgraduate training, and any additional certifications or qualifications.
• Provider’s professional employment history, previous practice locations, specialities, and any malpractice claims or disciplinary actions.

2) Primary Source Verification

• Medical licenses such as state medical board verification.
• Board certifications.
• Confirming provider’s educational qualifications from the institutions they attended.
• Malpractice claims and disciplinary history verification through the National Practitioner Data Bank (NPDB).

3) Credentialing Application Submission

• Credentialing with Medicare/Medicaid
• Insurance network and payers application
• Review of Credentialing Application
• Approval/ Denial
• Contract Negotiations and Agreements
• Provider Enrollment with Government Programs, if applicable
• Continuous Monitoring and Re-Credentialing
• Ongoing Maintenance