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Provider Credentialing and Enrollment Services

A physician or other healthcare practitioner who want to treat patients who are members of a certain Payer's plans must first get credentialed, i.e., enrolled and attested with the Payer's network and approved to perform the Services in question. The Payer checks the doctor's credentials (such as their education, license, experience, certifications, affiliations, malpractice, adverse clinical events, and training) to ensure they are up to par before allowing them to treat patients.

Doctors who aren't credentialed and enrolled with a specific insurance company may have their payments held up or perhaps be denied entirely. The practice's bottom line suffers as a result of these factors. Doctors can rely on our individualized Payer certification and enrollment Services.

Our customized Payer credentialing and enrollment Services support physicians in :

  • Starting or joining a new practice.
  • Transitioning to a new medical group.
  • Participate in new activities or organizations.
  • Sign up with a new insurance provider.
  • Keep up with their credentialing Services.


  • Gather from the doctors all the information and paperwork needed to submit credentialing applications.
  • Use our safe document management software to save all your files in one place.
  • Determine which insurance companies are the practice's major payers and reach out to them.
  • Following a thorough audit, use the payer's preferred format.
  • Promptly checking in with the Payer on the application's progress.
  • Get the enrollment number from the Payer, and let the doctor know where the application stands.
  • Credentialing-related document repository updated on a regular basis.


Our Provider Credentialing Services Include:

New Registrations/Renewals of an Individual Provider :

  • With the State
  • With the Drug Enforcement Agency (DEA)

Provider Data Maintenance - Update Management on Payer Systems :

  • Payers' files have been updated with new demographic information for providers. (Changes in the Provider's area of expertise or completion of advanced degrees).
  • Upkeep of a payer's online provider list. (Doing some research on the payer's website to double-check info like the provider's phone number, fax number, and address. Payers' records have been updated.
  • Enrollment of EFT/ERA Applications

Contracting Creation and Maintenance :

  • New Group/Individual Practitioner contracts
  • Adding / Deleting providers in the existing contract
  • Adding/Deleting location in the current contract
  • Adding / Deleting plan types ( Line of Business ) in the current contract
  • Rate Negotiation

CAQH Attestation :

Council for Affordable Quality Healthcare, Inc. eliminates redundant and inefficient administrative processes between health plans and providers for credentialing, directory maintenance, coordination of benefits, and other essential business functions.

  • CAQH application filing
  • CAQH quarterly attestations

Expirations and Renewals :

  • The tracking expiry date for State DEA License, Board certificate, and Malpractice Insurance

Tracking and Analytics:

  • Maintaining a repository of provider’s credentialing documents
  • Maintaining Contracting agreements
  • Tracking credentialing dates, expiration, and alerting dates to initiate credentialing processes
  • Working with the denials team to understand if there are any claim denials due to credentialing issues

Benefits of our Credentialing and Enrollment Services

With our diligent credentialing and Enrollment Services, you get the following benefits:

  • Get credentialed faster with all significant payers
  • Reduce claim denials and improve cash flow
  • Get more patient referrals from the network
  • Avoid piles of paperwork with our document management system
  • Get support for filling up cumbersome application forms
  • Reduce costs of the credentialing process with our global delivery teams
  • Get timely reports on the status of your applications

RM Healthcare handles more than 250,000 patient support calls each month