Provider Credentialing & Payer Enrollment

Streamline Payer Network Access With Our Provider Credentialing & Enrollment Service

Provider credentialing service is necessary to receive in-network reimbursement from payers. The ability to accept patient insurance plans is essential for the success of your practice. Procrastination and haphazard credentialing application processing can result in significant cash-flow challenges for your providers. Fortunately, there are ways to minimize issues with credentialing.

The process of affiliating a provider with payers, known as provider credentialing, is a crucial aspect of the revenue cycle. It enables the provider to treat patients within the network and receive compensation for the services provided. If a provider is not enrolled with an insurance payer, a patient may be unable to seek their services due to plan restrictions. Our credentialing team collaborates closely with the payer to guarantee the prompt receipt, processing, and approval of all necessary documents, allowing the provider to begin treating patients without delay.

Key Benefits of Our Provider Credentialing and Enrollment Services

• Ensure your information is up-to-date with payers
• Expedite insurance payments and increase patient referrals
• Minimize revenue loss
• Eliminate the need for extensive paperwork and application forms
• Decrease denials and identify provider patterns
• Foster partnerships with various payers
• Receive immediate updates on the status of your credentialing and enrollment transactions

When Do You Need Provider Credentialing Solutions?

• Opening a new practice
• In need of a larger patient base
• Adding provider(s)
• Moving or adding practice locations
• Expanding payer networks
• Mergers and acquisitions
• Re-credentialing providers

What do TriumpHealth’s Provider Credentialing Services Include?

Credentialing is the process of validating that a provider meets standards for delivering care; this includes verifying the provider’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.

Credentialing and Contracting Services

• New Group / Individual Provider contracts
• Adding / Deleting providers in the existing contract
• Adding / Deleting location(s) in the current contract
• Adding / Deleting plan types (Line of Business) within the current contract

Provider Demographic Updates

• Provider demographic updates

CAQH Registration, Attestations & Revalidations

• Keep track of the expiration date for State License, DEA #, Board Certificate, and Malpractice Insurance etc.

Tracking and Analytics

• Maintain all of the provider’s credentialing documents
• Maintain Contract agreements
• Track credentialing dates, expiration, and alerting dates to initiate credentialing processes

How Does TriumpHealth Help?

• Our team analyzes the demographics around your practice location and shortlists the most beneficial payers for you according to the patient density, enabling you to make an informed decision about what works best for your practice
• We track all applications submitted and maintain accurate records
• We contact you regularly to update you on progress until the process is over
• We have a consistent follow-up process that ensures payer timelines are met
• We guarantee the complete security, confidentiality, and accuracy of your data
• By trusting us, you can avoid common credentialing mistakes that lead to denials and underpayments

TriumpHealth Provider Enrollment Process

Documentation: Data collection of all legal, financial, and organizational documents from providers and organizations for application filing and submission with private, commercial & government payers.

Application Submission And Follow-up: Complete reconnaissance of current provider enrollment status. Submit applications with desired payers and complete timely follow-ups with payers to track application statuses.

Ensure Enrollment: Receive a countersigned copy of the contract and/or verify that the provider has in-network participation with written confirmation from the desired payer.

TriumpHealth is here to ensure that your office obtains its credentials accurately and on time so that you can begin receiving reimbursement as soon as possible. Missed deadlines and incorrect documentation cause an already time-consuming process to become a nightmare. We have the experience and knowledge you need to get you through the process with the least amount of worry. Your office simply needs to provide us with the required information and documents – and then leave the heavy lifting for us!

To talk to a representative, call 888-747-3836 x0 or email sales@triumphealth.com.