Credentialing and Privileging Services
Credentialing is the process of assessing and confirming the license or certification, education, training and other qualifications of a licensed or certified health care practitioner (MDs, PAs, NPs, etc.).
Privileging is the process of authorizing a health care practitioner's specific scope and content of patient care services at an affiliated facility such as a hospital, surgery center or skilled nursing facility.
These distinct processes can take 90-120 days from start to completion.
Credentialing and Payer Contracting
As part of our services for a new provider we will complete enrollment with all contracted health plans, including federal and state Medicare and Medicaid. These services include assisting the provider in completing a standardized credentialing application as well as updating and maintaining the provider's profile with the Council for Affordable Quality Healthcare database (CAQH). We also assist with completion of PECOS and NPPES requirements.
Re-Credentialing and Maintenance
As part of our services for an established provider we will maintain the revalidation of a provider’s licensing and certifications, etc. This generally occurs every two to three years. In addition, we maintain a provider’s CAQH re-attestation status, which occurs every 120 days. Congruently, we provide regular updates to a provider’s centers for Medicaid and Medicare services profile.
Facility Privileging
As part of our services, should a provider require privileges to care for patients at a given facility, we will contact and assist in the completion of required medical staff documentation.