NSMD is a leading Medical Credentialing Service Provider. Our outsourced credentialing services remove administrative hassles, ensure in-network status, and speed up reimbursements. We’ve helped doctors, nurses, and therapists advance in their careers. Join the many satisfied professionals through our Doctor Credentialing and Enrollment Services.
NSMD provider enrollment services secure in-network contracts, even with exclusive payer panels.
Credentialing, also known as insurance or doctor credentialing, is the process of verifying a healthcare provider’s qualifications, skills, and legitimacy. This ensures that providers have the necessary licenses, certifications, and education to deliver healthcare services.
Only credentialed providers are eligible for payments from payers and to work in compliance with state and federal regulations. Medical credentialing allows physicians to practice in specific facilities and participate in insurance networks like CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield.
As a provider, you want quick credentialing to begin practicing and billing legally and ethically. However, credentialing is a complex process requiring extensive documentation and verification at each stage by the insurance network. A single mistake can lead to denials and waste valuable time and money.
NSMD medical billing company provides top-tier healthcare credentialing solutions. Our experts manage everything from primary source verification to enrollment in premium payer networks, all in minimal time and within budget.
NSMD’s provider credentialing process is a certified and validated procedure that upholds the highest compliance standards. We boast a 98% success rate in getting providers approved for premium payer networks with maximum privileges in their specialties. The process generally follows these steps:
Our credentialing process starts with a thorough survey led by our credentialing specialists. This includes detailed interviews with providers to collect vital information such as license numbers, educational background, demographics, and professional history.
Our medical credentialing services help providers strategically select insurance partners that align with their practice goals and license type, while also finalizing insurance panels based on the practice’s location.
We handle CAQH application submissions, manage ProView accounts, and maintain up-to-date credentials for seamless primary source verification. Additionally, we assist with payer credentialing submissions, ensuring fast integration into insurance panels and accurate profiles that improve network participation and patient care quality.
While the usual timeline is 60-120 days, our credentialing experts take proactive measures to speed up the process. Our team communicates with payers weekly, pushing for quicker processing and approval of your credentialing applications.
Once credentialing is complete, your application moves to the contract phase. At this stage, an in-network contract may be offered, including fee schedules and eligible CPT billing codes. We manage closed panel issues, advocating through appeals to secure your inclusion. With successful credentialing, direct billing becomes possible, often with preferred reimbursement rates for in-network providers.
Even as credentialing concludes, our support continues. We help you obtain all required hospital privileges, whether it’s admitting, courtesy, or surgical rights.
We provide ongoing oversight to ensure your credentials stay up-to-date and your status remains uninterrupted. Our experts carefully monitor credentialing expirations and conduct thorough daily and weekly reviews to keep your credentials active. You can trust us to manage your credentials with care.
NSMD credentialing company provides comprehensive provider credentialing services for healthcare professionals and organizations. Here’s a summary of the medical credentialing and enrollment services we offer:
We enroll providers in Medicare and Medicaid, the largest health insurance programs in the U.S., covering millions of Americans. This enrollment helps providers grow their patient base, boost revenue, and stay compliant with federal and state regulations.
We credential providers with commercial insurance payers like Aetna and Humana, private health insurers offering various plans and networks. Credentialing with these insurers allows providers to reach more patients and secure better reimbursement rates.
Our credentialing solutions assist both individual providers (Type 1) and organizations (Type 2) in obtaining and updating their National Provider Identifier (NPI), a unique 10-digit ID assigned by the Centers for Medicare & Medicaid Services (CMS). An NPI is essential for billing, reporting, and electronic transactions.
We help providers stand out from their peers. Our credentialing specialists manage and update each provider’s profile on the Council for Affordable Quality Healthcare (CAQH) ProView, an online database that verifies provider information for credentialing. Using CAQH ProView streamlines the credentialing process across multiple health plans.
Providers using our credentialing service can enroll in the Medicare DMEPOS program, which covers items like wheelchairs, oxygen equipment, braces, and diabetic supplies. Enrollment allows providers to offer these items to Medicare beneficiaries, enhance care quality, and receive reimbursement from Medicare.
We assist physicians in obtaining and renewing their hospital privileges, which grant providers the rights and responsibilities to practice within hospital facilities. With hospital privileges, providers can admit and treat patients, access hospital resources, and collaborate with other healthcare professionals.
Our credentialing team assists doctors in negotiating contracts with insurance payers, which outline the terms of the provider-payer relationship. By negotiating these contracts, medical practitioners can secure better payment rates, dispute resolution procedures, quality measures, and network inclusion.
Our medical insurance credentialing service handles the revalidation and re-credentialing process for each physician, along with maintaining their credentialing status with Medicare, Medicaid, and commercial insurers. With NSMD managing these tasks automatically, providers can stay eligible for these programs and avoid any disruptions or penalties.
Our credentialing and privileging specialists audit reimbursement issues like underpayments, denials, delays, or errors from insurance payers. Providers also receive accounts receivable (AR) follow-up services to collect outstanding payments. By addressing reimbursement issues and following up on AR, providers can boost cash flow, reduce bad debt, and optimize their revenue cycle.
We help healthcare providers secure and maintain their state medical licenses across the U.S. Since each state has unique licensing rules and processes, staying licensed ensures providers meet legal requirements, prove their qualifications, and reduce professional liability risks.
NSMD’s credentialing specialists assist providers in getting and renewing their DEA registration, which allows them to legally prescribe controlled substances in the U.S. Maintaining this certification ensures they can safely and lawfully provide these medications to patients.
Our physician credentialing services support providers in registering their labs under the Clinical Laboratory Improvement Amendments (CLIA), which set federal guidelines for testing on human samples. CLIA registration is mandatory for labs conducting tests related to diagnosing, preventing, or treating illnesses, or for health evaluations.
Searching for top credentialing solutions from expert credentialing companies nearby? With over ten years of experience, NSMD stands out as a leading provider credentialing service for medical practices in all 50 U.S. states.
We begin by carefully evaluating your practice’s unique needs along with your state’s regulations and the requirements of your target payers. Using our strong payer network and established relationships, we gather and validate all required documents, including licenses, certifications, insurance, and more, tailored to each payer’s specific standards.
For instance, when credentialing a physician in California, we confirm their license with the Medical Board of California, check the National Practitioner Data Bank for any disciplinary records, review malpractice coverage, and collect a current CV and diploma before submitting applications to payers like Blue Shield of California and Health Net.
NSMD also offers additional services such as re-credentialing, fast-tracked credentialing, and credentialing support for locum tenens providers.
Accurate credentialing is vital for healthcare providers to ensure quality care, build patient trust, and stay compliant. Our all-inclusive credentialing support assists providers across all specialties in managing these requirements. We offer payer enrollment credentialing services for:
Our credentialing service helps physicians quickly join insurance networks, speeding up access to patient care. It plays a key role in upholding professional credibility and trust within the medical community.
Through our credentialing service, PAs and NPs can broaden their practice scope, securing authorization to provide critical medical care independently.
Credentialing with us simplifies hospital operations, ensuring smooth insurance claims processing and promoting seamless collaboration among medical staff.
Our credentialing services help therapists join insurance panels, allowing them to provide essential rehabilitation services and maintain financial stability.
Credentialing with us enables podiatrists to provide specialized foot care, establishing them as recognized experts in their field.
Our credentialing service strengthens chiropractors’ position in the medical field, giving them access to insurance networks and broadening patient outreach.
Credentialing through our service boosts patient trust by showcasing compliance with strict quality standards, essential for ensuring safe surgical procedures at ASCs.
Our credentialing ensures urgent care facilities are included in insurance networks, providing timely and affordable medical services to a wider patient base.
Credentialing supports diagnostic facilities and clinical laboratories in securing insurance approval, leading to more patient referrals and facilitating timely diagnosis and treatment.
Credentialing expands the reach of optometrists and audiologists, enabling them to provide vital eye and ear care services to a wider range of patients.
Our credentialing service helps behavioral health providers join insurance networks, ensuring essential mental health services are accessible to those who need them.
Examples include – Medicare, Medicaid, and TRICARE.
Examples include – Blue Cross Blue Shield, Kaiser Permanente, Anthem, United Healthcare, Aetna, Cigna, and Humana
Credentialing doesn’t have to be a hassle with us. We have the expertise, resources, and connections to get you credentialed and enrolled with any payer you choose. Regardless of your specialty or location, we’ll help you reap the benefits of being in-network!
