Credentialing Services - Pyramids Global
We provide credentialing and re-credentialing services to healthcare providers who wants to participate with several insurances. This includes but not limited to Government insurances and commercial insurances, Managed care, HMOs and choice plus plans.
Usually, we ask the following information from healthcare providers to being credentialing, however a relevant checklist is provided soon after you sign up with us:
- Current professional license(s)
- Current Drug Enforcement Administration and Controlled Drug Substance certificates
- Verification of education
- Post-graduate training
- Hospital staff privileges
- Levels of liability insurance
The credentialing process starts with requesting enrollment packets from government and commercial insurances. A signed package is sent to payers and then following up on the requests to make sure the timely processing of submitted correspondence. As soon as the credentialing the completed, we obtain provider numbers from the payers, setup EDI enrollments and start submitting claims for processing. A weekly follow-up report is also provided to the client for transparency and update. For re-credentialing, it is required after specific period of time when revalidation is required.
If you are a growing practice and wants to add new provider in your group, we are here to facilitate. A tax ID, group NPI and address is already there in insurance’s records. We will help make sure provider’s application has been submitted to the payer for adding the provider to the group with pre-defined effective date to consider old dates of service for reimbursements.