Medical Credentialing
Services for Healthcare Providers
Get medical credentialing services offering predictable, repeatable and scalable results with 100% guaranteed enrollment in Medicaid, Medicare and commercial insurer programs.
Why Credentialing Matters for Your Practice
Medical credentialing and enrollment is a long process used for onboarding new providers as well as established practices into different payer programs. Going through this process, a provider’s academic background, experience, certifications, medical license, clinic location is verified.
After these verification steps, insurers offer various programs, e.g., in-network and out-of-network enrollment to physicians, where they are allowed to offer medical care services to patients who have that specific health insurance. Payer enrollment services USA offers an easier and more scalable way to maximize your practice’s revenue.
Our Credentialing Services at Virginia Billing
Payer Enrollment Services
Reliable payer enrollment, credentialing and contracting for providers offer tailored solutions to expedite enrollment process with Medicare, Medicaid, & commercial payers efficiently.
CAQH Profile Setup & Management
CAQH credentialing solutions assist providers in creating their profile, getting verified so health insurers may check their competence and experience.
Insurance Contract Negotiation & Maintenance
Our Medicare and Medicaid credentialing services help practices obtain better reimbursement rates for covered services with timely annual fee schedule updates.
Re-Credentialing & Ongoing Updates
Provider credentialing services we offer support medical practices in recredentialing process, offering latest updates for expiration of medical license and timely applications.
The Virginia Billing Advantage
HIPAA & CMS-Compliant Credentialing
Our physician credentialing services are fully compliant with all local, state, and federal standards including HIPAA, CMS, NCQA.
Nationwide Coverage Across All States
We offer credentialing for private practice providers and large group practices from New York to Los Angeles, and Seattle to Texas.
Faster Insurance Approvals & Reduced Delays
Spotless credentialing applications create ways for faster approvals for providers, ensuring there’s no delay to treatment offering to patients.
Dedicated Credentialing Specialists for Every Provider
We assign a dedicated credentialing team that has complete know-how of every medical specialty, facilitating this critical step efficiently.
Step 1
Provider Data Collection & Verification
Step 2
CAQH Enrollment & Profile Maintenance
Step 3
Payer Applications Submission
Step 4
Contract Negotiation & Follow-up
Step 5
Approval & Ongoing Compliance Suppor
Who We Serve
Independent Physicians
- Group Practices
- Our medical coders are
AHIMA & AAPC-certified
- Specialty Clinics
(Mental Health, Pediatrics, Surgery, etc.)
- Hospitals &
Multi-Location Healthcare Facilities
- Small clinics & large
group practices
- Rural health and
community healthcare clinics
- Licensed Therapists
(LCSW, LPC)
- DMEPOS Providers
Frequently Asked Questions (FAQs)
The credentialing procedure in Virginia and across the US may take up to three months. However, delays can occur as a result of insufficient information or insurance company mergers. To avoid delays, gather all essential paperwork precisely and follow up with the insurance company on a frequent basis. Outsourcing medical credentialing services in Virginia allows providers to start this lengthy process accurately right from the beginning, ensuring your application is accepted at first submission and no time is wasted in edits and resubmissions.
A physician credentialing process involves various documents for verification of a provider’s experience, expertise, license and educational background. The document needed for US-based providers includes:
- Personal information (name, education, etc)
- Malpractice Insurance
- DEA (federal) and state CDS certificates
- Practitioner licenses
- Board certifications
- Current driver’s license
- Current CV showing current employer
- Diploma copy proving your highest level of education
- Additional information like Clinic name, location, etc
Yes, our team of credentialing experts are well-versed in CMS (Centers for Medicare & Medicaid Services) guidelines. We help healthcare providers in getting credentialed for Medicaid and Medicare enrollment plans. Additionally, our medical credentialing staff has complete knowledge of CMS guidelines and policies for providers, ensuring your practice stays compliant with Medicare, Medicaid and commercial payer policies without suffering from non-compliant practices resulting in penalties and fines.
Recredentialing is the periodic renewal of your enrollment status with insurance payers before the expiration of your credentialing status , typically every 5 years. Our team manages the entire process and applies for new credentialing approval 3-4 weeks before expiration date. Although it varies between different payers like Medicare, Medicaid and commercial insurers, a common timeline is after every 5 years. DMEPOS providers have shorter recredentialing periods between 2-3 years due to complexities, changing policies, expensive treatment and equipment requirements, etc.
Virginia medical billing is a professional company helping you avoid missed deadlines, reduces administrative burden, and ensures compliance. It also speeds up approvals and increases your chances of getting enrolled correctly the first time without delays or resubmission of credentialing applications.
Moreover, our skilled and certified staff help your healthcare organization in negotiating better terms with different payors like UnitedHealthcare, Aetna, Humana, Medicaid and Medicare for maximum privileges and reimbursement rates.
Lastly, we also offer provider credentialing services for a variety of healthcare organizations like solo and group practices as well. Our tailored solutions are created as per your needs, facilitating and supporting the revenue cycle of medical professionals.