Medical Credentialing

Your Trusted Partner In Medical Provider Credentialing Services and Enrollment

At HPARAS, we specialize exclusively in delivering fast, reliable, and customized medical credentialing services to healthcare providers across the United States.

What is Medical Credentialing?

Credentialing, in general, is used in various contexts in different fields. In this instance, the term credentialing refers to Medical Credentialing or insurance credentialing. Both Medical Credentialing and Insurance Credentialing are used interchangeably. Physicians and other healthcare practitioners, such as a hospital, a counseling office, a chiropractor, a Dentist, a Physical Therapist, an Occupational Therapist, an optometrist’s office, Urgent care, a Treatment center, a Social worker, etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.

Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase.

Our Comprehensive Medical Credentialing Services

1

Provider Enrollment

We assist healthcare providers in enrolling with insurance networks, Medicare, Medicaid, and other payer organizations by completing and submitting enrollment applications.

2

Primary Source Verification

We ensure accuracy and compliance with regulatory standards, as we authenticate education, training, licensure, certifications, and other relevant information directly from the issuing institution or authority.

3

Hospital Privilege Credentialing

We assist healthcare providers in obtaining and maintaining hospital privileges by managing all credentialing documentation, verifications, and compliance requirements.

4

Ongoing Monitoring and Re-credentialing

By proactively managing credentialing requirements and monitoring changes, we help healthcare organizations maintain regulatory compliance and streamline administrative processes.

Tailored Credentialing Solutions for Healthcare Organizations

1. Insurance Plans: Covering more Services than Ever

Medical credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include mental health and behavioral health parity, as well as fewer restrictions on pre-existing conditions and the coverage of supplemental services. These services include physical therapy, massage therapy, acupuncture and others. However, the cost of health insurance in the United States has increased accordingly. Persons invest heavily into their health insurance plans, and you better believe when they need healthcare services—be it general medical care, emergency medical care, dental, chiropractic, optometry, or mental health services, or anything—patients desire (even demand) to use their health insurance plans when seeking those healthcare services.,regard
2. Insurance Panels: Getting Full and Closing

Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.

We are also very familiar with the licensure process of behavioral health providers, including Licensed Professional Counselors (LPC), Licensed Mental Health Counselors (LMHC), Licensed Professional Clinical Counselors (LPCC), Licensed Clinical Professional Counselors (LCPC), Licensed Independent Clinical Social Workers (LICSW), Licensed Clinical Social Workers (LCSW), Licensed Psychologists, Licensed Marriage and Family Therapists (LMFT), and many others. We understand that a designation in one state (such as LPC, LCSW) might not be interpreted as the same level of certification on another state and we can help you navigate the challenges these nomenclature variants can cause.

Every year, we at Credentialing.com provide Medical Credentialing and Provider Enrollment services that help hundreds of healthcare practices (and thousands of providers) across the United States (from New York, to Alaska, To Hawaii) become credentialed with the best 3rd party payers.

Whether your healthcare practice is looking to join the preferred provider network with Blue Cross / Blue Shied or is looking to become paneled with Medicaid, our highly-trained credentialing specialists can help.

For many healthcare providers, credentialing is a constant hassle. We, on the other hand, make credentialing easy.
3. Help Getting on Insurance Panels

If you’re looking for a medical credentialing service that can take the burden of getting on insurance panels off of your plate, consider us at SPEEDY CREDENTIALING. We’ve helped thousands of providers and practices get credentialed and we’d love to talk with you about our trusted and effective credentialing service. Please feel free to call us at: (959) 240-0580.