Credentialing / Provider Enrollment
The Medical industry interchanges the word credentialing to describe primary source verification, as well as payer enrollment so knowing what credentialing means can get confusing. Payer enrollment is the process for a physician to request participation in an insurance plan as a participating or in-network provider.
Commercial payers require re credentialing every 3 years.
The council for Affordable Quality Healthcare, Inc. is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. CAQH is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans. By setting up a CAQH account, and keeping this account updated, you can easily enroll or revalidation easily. Most payers will re=credentialing automatically by accessing your CAQH file.
Medicare/Medicaid requires revalidation every 5 years for providers, every 3 years for DME supplies. Every new Medicare enrollment starts with setting up a I & A account. Which will be set up when a provider starts a Medicare application.
When you sign up with Quantum Solutions. We will credential you for all your provider enrollments. From start to finish. We will advise when a revalidation is required. You are working with a great company with 30+ years of experience.