Top Medical Credentialing Mistakes You Should Avoid

Maintaining the highest quality of care for all patients in the United States requires many facets and attention to detail. One of the most important of all these quality care standards is medical credentialing. It plays a role not just in making sure that patients are seeing the best possible provider for their condition. It also is crucial in claim submission, determining reimbursement rates, and ensuring that you or your practice is adequately compensated by various medical insurance providers. [...]

By |December 26th, 2022|Categories: Tips|Tags: , |0 Comments

Letter of Interest for Insurance Credentialing Tips

A lot of small practices and solo practitioners send a letter of interest to an insurance carrier in hopes of getting paneled with them, as a credentialed in-network provider. In a lot of ways, a letter of Interest is very similar to a cover letter though there are some significant differences. With a cover letter like you might write when applying for a new job, you’re really only sending a small amount of information. Usually, a resume or an [...]

By |December 4th, 2022|Categories: Tips|Tags: , |0 Comments

Contracting vs. Credentialing ABA Therapy. What’s the difference? Which Comes First?

Contracting and Credentialing are critical components of any successful medical or psychological practice. It is especially important for small practices and Applied Behavioral Therapy practices. Though understanding the finer points of each, and which one needs to come first requires a little bit of a deep dive into some important details. What Is Credentialing? Credentialing plays a critical role in provider qualifications as well as reimbursement rates. Not to mention the licensing necessary to practice in most communities. It [...]

By |June 30th, 2022|Categories: Tips|Tags: , |0 Comments

Top Credentialing Related Denials & How To Avoid Them

Claim denials are one of the most common causes of inconsistent revenue streams throughout the medical and mental healthcare industries. Not only does it cause delays with incoming revenue, but many require a response to questions, or appeals, which further rob your thriving practice of valuable time that could be better spent treating patients. Of course, this also means that one of the top goals for any competent autism billing company, all healthcare providers, and administrative billing staff is [...]

By |May 3rd, 2022|Categories: Tips|Tags: |0 Comments

Retroactive Reimbursement Requirements For Credentialing

In many states, the law requires carriers to pay for covered services provided to the member during the credentialing process at the in-network benefit level and under the terms of the contract. To apply, the credentialing application must ultimately be approved by the carrier. Credentialing Requirements All health plans are legally required to use a database that is created and maintained by OneHealthPort/Provider Source for credentialing purposes. This includes non-delegated credentialing, where the medical staff services department of a [...]

By |March 6th, 2022|Categories: Tips|Tags: , |0 Comments

What Is Medical Credentialing & How Does It Work?

Medical credentialing is a professional process that helps to establish and maintain effective standards throughout the medical community. Its central goal is to promote patient confidence and ensure the highest quality of care. Though it also plays an important role in verifying a practitioner's license, their education, and streamlining other important information necessary to provide services and work with insurance companies. An organization confirming an individual’s medical credentials will typically contact the certification boards and licensing agencies. This might [...]

By |November 10th, 2020|Categories: Tips|Tags: |0 Comments