We take the pain out of Medical Credentialing

Medical credentialing is the process of authenticating the qualifications of licensed medical professionals. It assesses their experience, education, competency, and training for legitimacy. As such, it is vital step for physicians and other healthcare practitioners who must bill insurance companies, if they are to receive compensation for their services. Moreover, credentialing can sometimes include granting or reviewing special clinical privileges, both for physicians and other healthcare practitioners. For this reason, many healthcare institutions and provider networks often conduct their own credentialing either through credentialing specialists or credentialing committees.

Why choose Horizon Office Technologies to do your medical credentialing?

Horizon Office Technologies understands the importance of maintaining good-standing credentials at all of your affiliated institutions. Being properly compensated is very important to keeping your medical business functioning, so we are here to help simplify the process. We understand that medical practices come in many different sizes, and offer different specialties; we have medical credentialing packages to suit the business needs of your medical practice, no matter the size or type. For this reason, we do not offer a ‘one-size-fits-all’ solution. Your medical practice is unique, so we offer three credentialing packages and credentialing maintenance services to suit your practice’s needs. For a small fee, our devoted and highly-trained staff will maintain your credentials and remind you of all deadlines and updates, to ensure that your contracts and licenses stay current and your practice compliant with regulations.

Certified, trained staff with superior knowledge Of the Medical Credentialing process

Because we understand the medical credentialing process, we know what you need to get started and remain in good-standing. All  healthcare practitioners who bill insurance companies to receive reimbursement for their services must undergo the credentialing process. The process includes a credentialing application, detailing your training and qualifications to treat patients within your unique specialties. The National Committee on Quality Assurance (NCQA) sets the standards for credentialing. Some of the review criteria includes:

• Education
• Board Certification
• Work History
• Current State License
• Current Malpractice Insurance Policy
• Current DEA License
• Clinical Privileges Validated
• Sanction History
• Claims History

However, simply meeting these base-standards is not always enough. After receiving your information, insurance companies must also determine whether you meet their internal qualifications to serve as a healthcare provider to their insured customers. Once your credentials have been approved, the insurance company then issues a participating-provider contract, which allows you to bill the insurance company and receive reimbursement as an in-network provider.

Medical Credentialing solutions customized to your practice needs

At Horizon Office Technologies, we understand the importance of insurance reimbursements to your business’ bottom line. Therefore, we work with you and your staff to ensure that your credentialing needs are met, so that your practice can reach financial success. Whether you are a single-physician location with only one affiliation, or a multiple-practitioner location with many affiliations, our staff is here to support your credentialing needs and ensure regulatory compliance. Our simple credentialing-maintenance process works hard for your business, so that you can focus on your patients. We take the hassle out of the medical credentialing process, and work to ensure that your provider-credentials remain current in standing. As we are physician advocates, our mission is to help you manage the ever-changing administrative side of your practice, so that you can focus on your real job; practicing medicine.

Although the size of your practice determines the level of credentialing services you and your staff need to maintain, we know you don’t want to pay for more than you need. Our highly-trained staff will work with you to ensure your requirements are met by following one of our credentialing packages. All of our credentialing and maintenance packages include:

• Application completion
• Plan-approval verification
• Change of office or payment-address
• Contract delivery

Credentialing for Larger Practices

For locations transitioning from single-physician practices to group-practices, or joining other group-practices, we offer the following services:

• Single-office location with multiple affiliations
• Single-practitioner to group-practice transition
• Application and coordination for Physician Hospital Organization (PHO) or Independent Practice Association (IPA)
• Ancillary service-agreements
• Direct contracts with multiple plans
• Hospitals with pending privileges

Comprehensive Credentialing Packages:

• Multiple new practitioners
• Multiple-office locations
• Unlimited practitioner credentialing
• Multiple hospitals with pending privileges
• Application and coordination for multiple PHO/IPA
• Tax-ID changes on established contracts

Make your medical credentialing process less stressful for you and your staff, by calling us today at (224) 238-4200, or complete our secure information form. Our highly-trained staff is ready to help your practice now!