Provider Services

Initial Credentialing

Initial credentialing services are available for providers who are currently not participating with any insurance panels. These services include the creation or maintenance of NPPES listings and the provider’s CAQH profile. Initial applications for enrollment along with all supplemental materials will be completed by me. I will also create all new provider profile accounts with applicable insurance panels and enroll you in EFT upon request. I currently offer credentialing services for the following panels:

  • Aetna Behavioral Health

  • Anthem Blue Cross and Blue Shield (all divisions)

  • Beacon Health Options - Commercial Division

  • Evernorth Behavioral Health

  • Magellan Healthcare

  • Medicaid

  • MultiPlan Healthcare

  • OPTUM

  • UPMC

If you do not see a panel listed that you are interested in joining, please contact me as many of these panels have different names and divisions per state.

Once all materials are completed on my end, I will submit each application and continue to follow up with each panel to ensure you are moving forward in the process. Please note that initial credentialing takes a standard 90 - 120 days from when a department starts to review your application - NOT from the time I submit it to the panel. This is a standard procedure in which I do not have control over.

Post credentialing

Life after initial credentialing does not stop. After you have become an approved in-network provider, you are still obligated to keep your contract up to date. During the course of your contract, you will receive provider demographic updates as well as re-enrollment or re-credentialing applications. Each insurance panel varies on the frequency of these occurrences and depth of paperwork required.

I can help create the seamless flow of work by completing these items for you as they are received. Using me for your post credentialing needs not only ensures it is done correctly, but ensures it is completed in a timely manner, keeping your contracts up to date.

Provider management

Beyond applications and credentialing is the responsibility of managing yourself as a provider. I provide data management of all of your information and help you navigate your provider profiles. Services included in provider management are:

  • CAQH profile maintenance

  • NPPES profile maintenance

  • All insurance provider profiles maintenance

  • Demographic changes

  • Record retention

  • General inquiries