Credentialing Services

  • Credentialing comes before even bill your first claim is submitted. Failing to manage the credentialing and contracting process WILL cause loss in revenue. To most, credentialing is a long drawn out process, filled with completing applications, waiting on hold for provider relation representatives, and gathering lots of documentation. No worries! Here’s how we can help!

Obtaining an NPI
(National Provider Identifier)

A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).Intelli-Med will obtain this NPI for you with a turnaround time of just a single day.

New Provider

So you’re a new provider, and you’re ready to see your first patient. Not so fast! If you plan to accept insurance, you must credential with most insurance companies to receive reimbursement. We will help you credentialing and contract with the insurance companies of your choice. Starting a New Practice Maybe you were credentialed and contracted with your previous company. So many providers assume the credentialing and contracts will follow them to their new practice. This simply is not true. When a provider changes tax-id, often time’s new contracts will need to be obtained. If you change states, the credentialing must start from the beginning in the new state, if for national insurance companies. We can help get you credentialed and obtain new contracts under the new tax-id or your social security number.

Adding new provider in practice

Your practice is growing, and you need to add providers. Some insurance companies will require group contracts for practices with more than one provider. Each provider will need to be credentialed and either added to the group contract, or have an individual contact that will pay to the practice tax-id. We can help make sure each provider has completed the necessary application and contracts to ensure your practice is paid for services rendered.

New Insurance Company

At some point, your practice may decide to accept new insurance payers. This will require establishing contracts with the new insurance company. We can help you establish contracts and review the fee schedule for the new insurance company. Hire us to be your Credentialing Manager Keep your data up to date with each insurance.

  • Update CAQH
  • Medicare Revalidations
  • Maintain credentialing documents and contracts
  • Re-credentialing management

Frequently Asked Questions

How Does Provider Credentialing Work?

Healthcare institutions should have staff bylaws that guide administrative processes that ensure that healthcare workers provide competent and safe care.

All healthcare workers should understand that practicing clinical medicine is a privilege, and it goes hand-in-hand with first being credentialed. After the individual is credentialed, the next step is to address the privileges of practice, which depend on the evaluation of the provider’s clinical qualifications, training, and overall performance. For privileges and credentialing, the bylaws should address the following:

  1. The pre-application process to screen if a healthcare professional satisfies the basic criteria for working in the hospital
  2. Establish grounds for denying applications after the pre-application process
  3. Establish a process where the rejected healthcare worker can re-apply after the initial denial
  4. Have a process for rapid credentialing for locums, emergency staff, and short-term employment
  5. Have steps in place to limit the practice of medicine for those healthcare workers who do not follow guidelines or the standard of care is not satisfactory
  6. How to grant temporary privileges: Sometimes, an outside medical or surgical specialist may be asked to offer advice or perform a life-saving procedure. In such scenarios, the bylaws should be able to accommodate them.
  7. Granting emergency privileges to healthcare professionals in times of disasters (for example, during floods or earthquake, there may be an urgent need to have the staff to look after the patients.
  8. Establish a code of conduct rules for a healthcare worker who gets credentialed and the penalties for disregard
  9. Granting privileges with shadowing: Many times, physicians and surgeons from outside the United States may have different training. Before granting full privileges, these healthcare workers may need shadowing or proctoring for a few weeks or months. For example, many hospitals have a process of proctoring surgeons in cardiac surgery to ensure that they know what they are doing.