Service Detail

Provider Credentialing Services

Before a provider or organization can bill an insurance carrier, the provider must first be credentialed by the carrier. Credentialing is the process by which a health insurance carrier formally assesses a provider’s qualifications and competency based on demonstrated competence. This can be a time consuming process; here HMS USA INC provider credentialing services can help their clients by gathering all the requirements and processing them so that they can save time and resources.

Credentialing & Re-credentialing:
Credentialing and re-credentialing is an ongoing review process to assure the current competence of practitioners by validating the training and competence of individual practitioners in particular specialty areas. This level of review is intended to provide verification that the appropriate training, experience, qualifications, and ongoing competence has been demonstrated by individual practitioners for the services they provide.

Dedicated Team:
A team that completes the credentialing details and submits it to commercial Insurances, Medicare and Medicaid, as requested by healthcare physicians.

Compliance:
Our Credentialing Services ensure compliance with the National Committee for Quality Assurance (NCQA) and the Department of Health and Family Services (DHFS).

Crucial Follow Ups:
A Dedicated team which handles credentialing services always ensures that all the matters regarding the service are performed in a proper manner.

Portal Registrations:
Create and update CAQH & PECOS credentialing portals

Contracting Issues & Data Integrity:
Our experts perform a proper audit, keeps a keen eye on all the issues raised while the data is being processed and resolves them at the earliest.