PHYSICIAN CREDENTIALING

PHYSICIAN CREDENTIALING

Before a physician can begin receiving insurance reimbursements, the physician must be credentialed. This process requires the billing physician to be properly, and officially, linked with insurance carriers and government agencies like Medicare and Medicaid. Just like obtaining professional licenses, getting credentialed is essential to running a smooth, profitable practice. Credentialing is labor intensive, and requires comprehensive documentation covering a physician’s education, experience, and professional activity since the physician graduated from Medical School. For all new or relocated physicians in any specialty nationwide, Lloyds Solutions affords complete and affordable physician credentialing services. We take care of the endless paperwork, so that you can spend your time treating patients.

Our credentialing experts at Lloyds will process and file documents for: Government Enrollments, Health Plans Credentialing, State Applications, CAQH, License Renewals and Primary Source Verification. During the process, we will:

  • Complete all initial, and re-credentialing applications
  • Mail/transmit application to third party payers and/or affiliations
  • Follow-up with payer/affiliation to ensure receipt of application
  • Maintain consistent communication through the credentialing process with payers/affiliations
  • Report to clients for each entity at client-determined intervals
  • Confirm participation/privileges to clients
  • Prepare contracting documents for scanning and Long-term electronic storage.
  • Prepare, maintain and monitor Managed Care Summaries that Provide Effective dates, Fee Schedule details and Group affiliation
  • Maintain your documents such as medical license, DEA, malpractice insurance, etc. and alert you prior to documents expiring
  • Maintain and Update specific Provider information directly with carriers at frequent intervals or when requested
  • Resolve enrolment issues and track Managed Care contracts
  • Validate information provided by Payers
  • Prepare paper CMS 855 & other Managed Care applications for all Payers
  • Manage your CAQH file and keep all information up to date
  • Manage your NPI file(s) and keep all information up to date
  • Track your CME history and let you know when your credits expire
  • Process all re-credentialing applications during your subscription period

When you get credentialed by Team LLOYDS here are some of the benefits you will receive:

  • Better payment: Commercial Medical Insurance carriers pay physicians who are on par with their insurance, in effect, paying credentialed physicians better and quicker than non-credentialed physicians. Consequently, patients who are treated by these physicians also benefit, as physicians do not have to bill them.
  • More patients: Credentialed physicians are listed in the Preferred Physicians Group from which patients usually select their physicians in order to get maximum benefits and to avoid out of pocket expenses. Therefore, credentialed physicians get more patients.
  • Improved quality in healthcare: Healthcare fraud is common in the US these days. Since physician credentialing involves a complete background check of the provider’s educational qualifications, professional licenses, experience, fellowship programs, and residency, credentialing helps in controlling healthcare fraud-related crimes, ensuring that only qualified physicians deliver services to patients.
  • Liberty to choose the fee plan: By being in par with the insurance carriers, physicians can choose the best, most profitable, fee plan. Physicians can either select a fee per service, or take up the capitation fee model based on the average number of patients served per month within network.
  • Access to the fee schedule: The exact fee schedule for different medical procedures and services are accessible to Physicians who are in par with the insurance carriers. This fee schedule will determine the maximum reimbursement limit for different services and will help physicians in processing their claims accordingly.
  • Positive Marketing: A thorough physician credentialing plan can provide a positive marketing benefit to a network provider. Many Managed Care Organizations (MCOs) attract large numbers of members through their cost-effective plans. By credentialing to these MCOs, which may have millions of members subscribed to these plans, the healthcare professiona has an excellent chance of being chosen by patients near the practice location.
  • Save on Resources: By outsourcing your credentialing process to Lloyds Solutions, you will free your office staff from time-consuming paperwork to complete your credentialing or re-credentialing applications. Lloyds Solutions will make sure you will never miss another filing or re-credentialing deadline. We have the tools, knowledge, time and experience to help you with this complicated process.