Payer Enrollment

Payer enrollment is a process that allows providers and practices to be enrolled for the services they provide and verifies that the payers have the information they need to process claims that are filed. Becoming an in-network provider allows you to get paid for your services accurately and promptly.

TriumpHealth’s credentialing specialists monitor the process each step of the way to ensure that you are enrolled as fast as possible. We keep you updated and informed with any progress on you and your practice’s enrollment.

Steps of the Credentialing Process

1. Information Collection

Each provider or practice needing credentialing must supply information on the practice/his or her background, education, licenses, etc. Each provider must have a complete CAQH account that houses their personal information.

2. Information Review

The TriumpHealth credentialing team checks for completeness and accuracy of all information that is uploaded by the client. If any information is missing or outdated, we will notify the provider of what additional documentation is needed in order to complete their applications for each payer.

3. Letter of Interest Submission

Our credentialing specialists create a letter of interest (LOI) for each payer and submit them on each provider’s/practice’s behalf.

4. Application Creation

Our credentialing specialists complete each payer application with all necessary information provided by the client.

5. Application Submission

The applications are submitted to the payers and an answer regarding if the markets are open or closed should be received in 30-45 days.

6. Follow Up

Our credentialing team follows up on each application regularly and provides monthly updates to the client. The persistent follow up process that we have implemented allows us to hold payers accountable for the work that needs to be done on the applications.

7. Acceptance or Denial

A final decision regarding a provider being accepted into the network is made by the payer and the internal filing process for the payer begins. Once the internal filing is complete, the provider will be able to bill out according to the contracts obtained. In the case of a denial, our credentialing specialists can appeal to a payer up to 3 times for a client.

Credentialing Tips

Visit our blog that outlines how to streamline your credentialing process and obtain your contracts in a timely fashion.

Our team not only focuses on getting you enrolled, but we also ensure that your information is safe and secure throughout your enrollment process. We utilize a HIPAA compliant portal for easy and safe transfer of information between our clients and our credentialing specialists. We are dedicated to helping you focus on the job that you do best with a team behind you that you can trust.

Let TriumpHealth help you start maximizing your revenue today, contact us!