Physicians routinely ask us, “Why should I use your services when I can do this myself?” While many practices can certainly perform these services internally, Nationwide Credentialing actually specializes in these services. Our seasoned team of professionals will effectively and efficiently steer your practice through the laborious contracting and credentialing process, utilizing state-of-the-art technology that allows us to process our clients’ applications in a cost-effective manner. We streamline and ease the administrative burdens credentialing creates in your office, reducing overhead by eliminating the need to hire someone to deal with the continued follow up managed care paperwork—allowing you and staff to get back to what you do best: practicing medicine!
Whether you are starting a new practice, adding a new physician, changing practice locations, breaking away from a group, or require primary source verification, Nationwide Credentialing is ready to assist you! Click each category below to find out more.
- Identify all managed care health plans available in the identified geographic area.
- Provide contract negotiations for managed care contracts on your behalf.
- Enroll physician(s) into all participating health plans and hospitals.
- Complete all re-credentialing applications and re-appointments.
- Obtain Medicare and Medicaid provider numbers.
- Obtain and Maintain CAQH.
- Obtain and Maintain NPI Numbers.
- Maintain current certificates; including: medical licenses, DEA and DPS certificates, malpractice face sheets, CLIA, board certification, PPD test, and CME’s. Reminder notices are sent at 60 and 30-day intervals.
- File and maintain your updated credentials with your local IPA’s and PHO’s; forward all updated licenses to contracted health plans and hospital affiliations.
- Request allowed amounts for your top 25 billing codes provided by each health plan.
- Assist the practice with a name change, Tax ID change, relocation, etc.
- Assist the practice in making sure the health plans have the correct demographic information on file.
- Maintain CME summaries.
- Obtain and complete all applications and agreements on your behalf.
Nationwide will review all physician information submitted in accordance with Joint Commission, state and NCQA requirements. All information is verified and made available for credential committees or hiring groups. Items verified on each physician application include:
- State license(s)
- DEA & CDS registrations
- Clinical privileges at primary hospital
- Board Certification(s)
- Malpractice Coverage
- Medical Education and Graduate Training
- Medicare/Medicaid sanctions
- National Practitioner Data Bank queries
- American Medical Association
One of the more important services offered by Nationwide Credentialing is that your contract management and fee schedule information is posted in a secure, password protected database on our website. This database is only accessible by those individuals that are designated for access. Your information is strictly confidential! Having contract information available online allows your staff to know the status as well as which health plans you accept. Having the fee schedule data on-line allows your billing department to make sure you are being paid correctly.