Credentialing and Provider Enrolment

Onboarding for Success

At DBS-Doctors Billing Solution, we specialize in simplifying this complex process. We act as your dedicated partner, expertly managing all aspects of provider credentialing and payer enrollment, ensuring your physicians, PAs, NPs, and other licensed healthcare professionals are swiftly and accurately set up to bill for their services. Let us handle the bureaucracy so you can focus on patient care.

Initial Assessment & Profile Setup

We begin with a thorough assessment of your provider’s qualifications, licenses, certifications, and practice information.We then create and maintain robust, up-to-date CAQH (Council for Affordable Quality Healthcare) ProView profiles, which serve as a central repository for provider data, streamlining applications.

Facility Credentialing & Privileging

For providers seeking privileges at hospitals, ambulatory surgery centers, or other healthcare facilities, we manage the intricate facility credentialing process. This involves preparing and submitting applications, ensuring compliance with facility-specific bylaws, and coordinating with Medical Staff Offices.

Re-validation Management

Maintaining active status is just as crucial as initial enrollment. We proactively manage all re-credentialing and re-validation deadlines for both payers and facilities, ensuring your providers’ billing privileges remain uninterrupted and preventing costly lapses in coverage.

NPI & PECOS Registration

We assist providers with obtaining and maintaining their National Provider Identifier (NPI) and ensuring proper enrollment in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), crucial for Medicare billing. This ensures seamless eligibility to bill Medicare services without disruption.

Dedicated Credentialing Specialists

Your practice is assigned a dedicated credentialing specialist who understands your unique needs and payer landscape. This personal approach ensures consistent communication and efficient progress throughout the entire process.

Proactive Monitoring & Problem Resolution

We don’t just process applications; we proactively monitor their status and promptly address any payer inquiries or roadblocks. This vigilance prevents unnecessary delays and keeps your providers on track for timely enrollment.

Centralized Data Management

All provider information and credentialing documents are securely managed and organized in our centralized system. This ensures easy access for updates and simplifies future re-credentialing cycles, saving your staff countless hours.

Frequently Asked Questions

What is the differ between credentialing and provider enrollment?

Credentialing is the process of verifying a provider's qualifications and competence, usually done by health plans and facilities. Provider enrollment is the process of registering a provider with payers (like Medicare or commercial insurance) so they can bill for services and receive reimbursement.

Why is professional credentialing and enrollment?

Proper credentialing and enrollment are crucial because providers cannot legally bill for services or receive reimbursement until these processes are complete. Delays can lead to significant lost revenue and operational disruptions for your practice.

How long does the credentialing and enrollment process take?

The timeline varies greatly by payer and facility, but it can range from 60 to 180 days or even longer for initial applications. Our expertise helps significantly reduce these timelines by ensuring accurate submissions and proactive follow-up.

What is CAQH ProView and how does DBS utilize it?

CAQH ProView is a universal credentialing application system used by many health plans. DBS utilizes and maintains your provider's CAQH profile, ensuring it's always current and comprehensive, which significantly streamlines the application process across multiple payers.

Does DBS handle both government (Medicare/Medicaid) and commercial insurance enrollment?

Yes, we manage comprehensive payer enrollment for all major government programs (like Medicare and Medicaid) as well as a wide range of commercial insurance carriers relevant to your practice.

How does DBS help prevent delays in the credentialing process?

We prevent delays through meticulous application preparation, expert knowledge of payer-specific requirements, proactive follow-up with payers, and a dedicated credentialing specialist assigned to your account.

Does DBS assist with re-credentialing and re-validation?

Absolutely. We proactively manage all re-credentialing and re-validation deadlines for both payers and facilities, ensuring your providers' billing privileges remain active and uninterrupted, preventing costly service gaps.

Can DBS help with credentialing for new providers?

Yes, our services are ideal for onboarding new providers, ensuring they are swiftly and accurately credentialed and enrolled with the necessary payers and facilities so they can begin contributing to your practice's revenue quickly.

How does outsourcing credentialing to DBS benefit my practice financially?

By accelerating the enrollment process and preventing billing delays due to credentialing issues, we help your practice start generating revenue faster from new providers and avoid potential revenue loss from lapsed credentials, significantly improving your cash flow.

What happens if a provider's license or certification expires during the process?

We offer license and certification monitoring as part of our service. Our team proactively tracks renewal dates and provides timely reminders to prevent any lapses that could impact billing eligibility or cause re-credentialing delays.

Medical Billing Team, Trusted Nationwide