Provider Credentialing Services
Streamline your credentialing process with our expert services. We handle the complexity so you can focus on patient care while we ensure fast, accurate credentialing across all payers and networks.
Credentialing Excellence
Our credentialing services deliver superior results with industry-leading approval rates and streamlined timelines
Our Credentialing Process
A systematic 6-step approach ensuring accurate, compliant, and expedited credentialing
Document Collection & Review
Comprehensive gathering and validation of all required credentialing documents including licenses, certifications, and education credentials.
We collect and verify medical licenses, DEA certificates, malpractice insurance, education transcripts, board certifications, and work history documentation.
Application Preparation & Submission
Expert preparation and submission of credentialing applications to all relevant payers and healthcare networks.
Professional completion of CAQH profiles, payer-specific applications, hospital privileges, and network enrollment forms with accuracy checks.
Primary Source Verification
Direct verification of all credentials from original sources to ensure authenticity and compliance with industry standards.
Verification of medical school graduation, residency completion, board certifications, license status, and malpractice history from primary sources.
Payer Network Enrollment
Systematic enrollment with insurance payers and healthcare networks to enable billing and reimbursement.
Enrollment with Medicare, Medicaid, commercial insurers, managed care organizations, and specialty networks based on practice needs.
Status Monitoring & Follow-up
Continuous monitoring of application status with proactive follow-up to expedite approvals and resolve any issues.
Regular status checks, documentation of progress, communication with payer representatives, and resolution of any delays or requests.
Completion & Maintenance Setup
Final verification of approvals and establishment of ongoing maintenance schedules for re-credentialing and updates.
Confirmation of effective dates, fee schedule negotiations, contract review, and setup of maintenance calendars for future renewals.
Credentialing Services We Provide
Comprehensive credentialing solutions for every type of healthcare provider and practice need
Initial Credentialing
Complete credentialing for new practitioners entering practice or joining new networks.
Services Include:
- New provider setup
- Fresh graduate credentialing
- Practice location additions
- Specialty board certifications
Re-credentialing
Renewal and maintenance of existing credentials to maintain network participation.
Services Include:
- License renewals
- Certificate updates
- Practice information changes
- Malpractice updates
Facility Privileging
Hospital and facility credentialing for admitting privileges and surgical procedures.
Services Include:
- Hospital medical staff
- Surgical privileges
- Emergency department
- Specialty facility access
Payer Enrollment
Insurance network enrollment and contract negotiations for billing authorization.
Services Include:
- Commercial payers
- Government programs
- Managed care networks
- Direct contracting
Payer Network Enrollment
We credential providers with all major payer networks to maximize revenue opportunities
Government Programs
Required for government reimbursement
Major Payers:
NPI, taxonomy codes, licenses, certifications
Commercial Insurance
Essential for private practice revenue
Major Payers:
Credentialing committee approval, contract negotiation
Managed Care Organizations
Critical for HMO/PPO participation
Major Payers:
Quality metrics, utilization patterns, peer review
Specialty Networks
Specialized revenue opportunities
Major Payers:
Specialty certifications, additional training
Advanced Technology Platform
Our proprietary credentialing platform streamlines the entire process with automation and real-time tracking
Credentialing Portal
Secure online portal for document upload, status tracking, and communication.
Key Benefits:
- ✓Real-time status updates
- ✓Document management
- ✓Secure messaging
- ✓Mobile access
Automated Workflows
Streamlined processes with automated reminders and status notifications.
Key Benefits:
- ✓Reduced processing time
- ✓Error prevention
- ✓Consistent communication
- ✓Deadline management
Integration Capabilities
Seamless integration with practice management systems and EMRs.
Key Benefits:
- ✓Data synchronization
- ✓Reduced data entry
- ✓Workflow efficiency
- ✓System compatibility
Compliance Monitoring
Continuous monitoring of regulatory changes and compliance requirements.
Key Benefits:
- ✓Regulatory updates
- ✓Compliance alerts
- ✓Risk mitigation
- ✓Industry standards
Specialty-Specific Credentialing
Deep expertise across medical specialties ensures accurate credentialing tailored to your practice requirements
Primary Care
Common Challenges:
- •Multi-state licensing
- •Preventive care credentials
- •Quality measure requirements
Our Solutions:
- ✓Streamlined multi-state process
- ✓Preventive care optimization
- ✓Quality reporting setup
Credentials We Handle:
Surgery
Common Challenges:
- •Hospital privileging
- •Surgical volume requirements
- •Malpractice considerations
Our Solutions:
- ✓Comprehensive privilege applications
- ✓Volume documentation
- ✓Risk management
Credentials We Handle:
Mental Health
Common Challenges:
- •Behavioral health networks
- •Telehealth credentialing
- •Specialized certifications
Our Solutions:
- ✓BH network enrollment
- ✓Virtual care setup
- ✓Specialty certifications
Credentials We Handle:
Emergency Medicine
Common Challenges:
- •Multi-facility privileges
- •On-call requirements
- •Rapid credentialing needs
Our Solutions:
- ✓Streamlined facility process
- ✓On-call documentation
- ✓Emergency credentialing
Credentials We Handle:
Ongoing Maintenance & Support
Comprehensive maintenance services to keep your credentials current and compliant
License Monitoring
ContinuousAutomated tracking of license expiration dates and renewal requirements across all states.
Features:
- Expiration alerts
- Renewal coordination
- Multi-state tracking
- CME monitoring
Insurance Updates
As neededManagement of malpractice insurance changes and policy updates with timely payer notifications.
Features:
- Policy tracking
- Coverage verification
- Payer notifications
- Claims monitoring
Demographic Changes
As neededEfficient processing of practice location, contact, and demographic information updates.
Features:
- Address changes
- Contact updates
- Practice additions
- Taxonomy updates
Re-credentialing Management
Every 3 yearsProactive management of re-credentialing cycles to maintain uninterrupted network participation.
Features:
- Timeline tracking
- Document preparation
- Application submission
- Status monitoring
Success Stories
Real results from our credentialing services across different practice types and specialties
Multi-Specialty Group Practice
15-provider group needed credentialing across 50+ payers in 3 states
Coordinated multi-state credentialing with staggered timeline management
100% approval rate completed 30 days ahead of practice opening
Emergency Medicine Physicians
Urgent credentialing needed for emergency department coverage contract
Expedited emergency credentialing process with direct payer contact
Emergency privileges granted within 10 days, full credentialing in 30 days
Telehealth Practice Expansion
Mental health practice expanding telehealth services across multiple states
Multi-state licensing coordination with telehealth platform credentialing
Licensed and credentialed in 12 states, 200% revenue increase
What Providers Say
Healthcare providers trust our credentialing expertise to get them enrolled quickly and accurately
"Healix RCM made our credentialing process seamless. They credentialed our entire practice in record time and kept us informed every step of the way."
Dr. Amanda Foster
Family Medicine Physician
Summit Family Health
"The expertise they brought to our complex multi-state credentialing was invaluable. They navigated every challenge and delivered exceptional results."
Mark Stevens
Practice Administrator
Regional Surgery Center
"Their technology platform made tracking our credentialing status so easy. We always knew exactly where things stood and what was coming next."
Dr. Lisa Chen
Emergency Medicine Physician
Metro Emergency Associates
Frequently Asked Questions
Common questions about our credentialing services and process
How long does the credentialing process typically take?
Initial credentialing typically takes 60-120 days depending on the complexity and number of payers. We expedite where possible and provide regular status updates throughout the process.
What documents do you need to start the credentialing process?
We need medical licenses, DEA certificates, board certifications, malpractice insurance, CV, education transcripts, and practice information. We provide a comprehensive checklist to ensure nothing is missed.
Can you help with emergency or expedited credentialing?
Yes, we offer expedited credentialing services for urgent situations. We work directly with payer representatives and utilize emergency credentialing pathways when available.
Do you handle re-credentialing and maintenance?
Absolutely. We provide ongoing monitoring and management of all credentialing requirements including license renewals, re-credentialing cycles, and demographic updates.
What happens if a credentialing application is denied?
We immediately investigate denial reasons, work to resolve any issues, and resubmit applications. Our 95% approval rate reflects our expertise in preventing and resolving credentialing challenges.
Can you help with hospital privileging and facility credentialing?
Yes, we manage hospital medical staff applications, surgical privileges, and facility credentialing. We work with hospital credentialing committees to ensure smooth approval processes.
How do you ensure HIPAA compliance during credentialing?
We maintain SOC 2 Type II certification and follow strict HIPAA protocols. All documents are encrypted, access is controlled, and we maintain detailed audit trails of all activities.
What are your fees for credentialing services?
Our fees vary based on the scope of services needed. We offer transparent pricing with no hidden costs and can provide custom quotes based on your specific credentialing requirements.
Ready to Streamline Your Credentialing?
Let our credentialing experts handle the complexity while you focus on patient care. Get started with fast, accurate credentialing services today.
✓ 95% approval rate ✓ 45-day average completion ✓ HIPAA compliant