Credentialing and Contracting Services

The credentialing process can be complicated and time consuming. We are here to help. Our professional staff can handle every phase of the process from determining eligibility to making the application to its completion.

Our service includes provider enrollment at the group practice and individual practice level. We work with all specialties and assist with enrollment in all insurance networks (Medicare, Medicaid, and Commercial Insurance). Our credentialing solution fits any practice regardless of size or specialty.

Our credentialing & contracting services include:

  • Provider enrollment services for physicians and healthcare entities (credentialing and contracting with health plans)
  • Medicare provider enrollment and re-validation services
  • Credentials verification for physicians and ancillary healthcare providers
  • CAQH and NPI registration
  • Managed care contracting
Kimberly Moore, Bonnie Waelde, and Michele Merriman are credentialing specialists for HSC Medical Billing
Kimberly Moore, Bonnie Waelde, and Michele Merriman

Our staff will work with any insurance company to get your practice providers enrolled with health plans and to maintain your providers credentialing files. The credentialing process varies by payer. The time period to obtain approval for participation in network and insurance plans is determined by each payer individually. We maintain a checklist and will routinely and consistently contact the payer to follow up on the status of pending applications. After submitting a complete application, we have no control or guarantee as to if/and/or when an applicant will be approved for participation. The approval for participation is determined solely at each payer’s discretion. Payers often change their guidelines and criteria without advance notice. We will notify you when we receive notification that the provider has been admitted for participation with the effective date. Some payers will backdate to the requested effective date while others will not. If the provider treats a patient insured by a payer or network before their participation effective date, the charges may be denied or paid at an out-of-network rate.

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