Credentialing process involves the following steps:
- Application Evaluation: Completing required documentation and identifying exceptions.
- Primary Source Documentation: Verify practitioner/ facility information from physicians
- Outbound Call Centre: Obtain missing documents and updating payer's database.
- Follow-up with Payers: Follow-up on submitted credentialing requests.
- Data Entry: Capture data, label and link images to specific providers/ facilities in payer's database.
- Maintenance of Provider Data: Update provider information as per policies and procedures, and CAHQ profile.
- EFT / ERA Enrolment
- Benefits of Using EFT: Improved Cash Flow
- (i) Funds are received and available for use in healthcare practice bank accounts the next business day after a plan initiates payment.
- (ii) Funds are available seven days faster than paper checks (on average).- Delays for checks includes mailing, deposit and funds clearance.
- (iii) No staff time required for bank visits to make deposits.