Credentialing (Insurances & Hospital)


Credentialing process involves the following steps:

  1. Application Evaluation: Completing required documentation and identifying exceptions.
  2. Primary Source Documentation: Verify practitioner/ facility information from physicians
  3. Outbound Call Centre: Obtain missing documents and updating payer's database.
  4. Follow-up with Payers: Follow-up on submitted credentialing requests.
  5. Data Entry: Capture data, label and link images to specific providers/ facilities in payer's database.
  6. Maintenance of Provider Data: Update provider information as per policies and procedures, and CAHQ profile.
  7. 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.