Credentialing and Enrollment
Trustworthy Credentialing and Enrollment partner, offering up-to-the-mark Credentialing Services
Credentialing isn’t a one-time task. Services evolve, and new regulations require updates. Regular recredentialing keeps your practice compliant. Skyshine Health Solutions’ experts manage this, ensuring hassle-free, up-to-date credentialing.
Credentialing expertise requires years of experience. Our seasoned professionals at Skyshine Health Solutions support all medical practices. They handle complex documentation, freeing you to focus on patient care.
At SkyShine Health Solutions, our Credentialing and Enrollment Services ensure healthcare providers stay compliant and eligible for reimbursements without delays. We streamline the complex process of provider enrollment, payer negotiations, and ongoing credential maintenance, so you can focus on delivering exceptional patient care. Serving solo practitioners, multi-specialty clinics, and large hospitals, our expert team leverages industry knowledge and advanced technology to eliminate administrative hurdles and protect your revenue stream.
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Our Credentialing and Enrollment Services
Initial Credentialing
We manage the entire initial credentialing process, from application preparation to submission and follow-up.
What We Handle:
CAQH profile setup and maintenance
Verification of licenses, certifications, and education
Submission to Medicare, Medicaid, and commercial payers
Coordination with hospitals and facilities for privileging
Our meticulous process ensures error-free applications, reducing approval times by up to 30%.
Payer Enrollment
We negotiate and secure payer contracts to maximize your reimbursement rates. Our team handles enrollment with all major payers, ensuring your practice is ready to bill promptly.
Supported Payers:
Payer Type | Examples |
|---|---|
Government | Medicare, Medicaid, Tricare |
Commercial | Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield |
Regional | Local HMOs, PPOs, and specialty plans |
We track enrollment status in real-time, keeping you informed every step of the way.
Re-Credentialing and Maintenance
Payer and facility re-credentialing requirements can be time-consuming. We proactively manage renewals to prevent lapses in eligibility.
Our Process:
Automated reminders for expiring credentials
Updates to CAQH profiles and payer records
Compliance with changing regulatory standards
Avoid costly disruptions with our proactive maintenance services.
Contract Negotiation and Optimization
Our experts analyze payer contracts to secure favorable terms, ensuring your practice gets the reimbursements it deserves.
How We Optimize:
Benchmarking against industry-standard rates
Identifying underpayment opportunities
Renegotiating contracts for better terms
Clients typically see a 10-15% increase in reimbursement rates after our contract reviews.
Lets experience our medical billing services
Over 500+ medical practices trust Skyshine Health Solutions medical billing services company. So let’s have a chat.
Patient's insurance coverage verification on the spot.
HIPAA-compliant medical billing services for data safety.
24/7 medical billing services to handle every claim submission.
98% claim reimbursement rate for healthy cash flow.
Why You Should Choose Us?
Our medical billing experts dive deep into your healthcare RCM procedures with the aim of earning clients’ satisfaction as a result. With this vision, we offer the most cost-effective, highly efficient and reliable medical billing solutions to our clients.
From patient eligibility verification to claim submission, our expert medical billing specialists pay attention to fine details in practice management. We make sure that your hard-earned income never slips through the loopholes.
We empower healthcare practices with robust support and insightful medical billing services. We ensure 100% accuracy through our professional healthcare RCM services to claim payments. We boost revenue with precise, efficient billing services.
Credentialing and Enrollment FAQs
Fundamentally, credentialing refers to the formal validation of a medical or healthcare provider in a specific private health plan and enabling the provider to get the approval to join the network. On the other hand, the act of enrollment refers to the process through which a provider requests participation in a health insurance network.
The standard duration to complete the credentialing process takes on average 90 to 120 days. However, if you hire credentialing experts from the billing sector, you can reduce the time frame to less than 90 days as well.
Privileging includes a health care facility, for instance, a hospital authorizing providers to practice specific kinds of medicine and carry out procedures accordingly on the premises of the facility. As opposed to this, the credentialing process involves regulating and checking the licenses and certificates of the medical providers. The goal here is to check whether the credentials are in good standing or not, and evaluate if the medical practitioner is licensed to practice in the health care facility.
A credentialed provider in the healthcare sector is someone who has been vetted by insurance companies or networks with all background information along with verification of the required credentials that enables the provider to offer a specific healthcare service in the industry.