Credentialing and Contracting

Credentialing is the process of confirming a healthcare professional’s qualifications to ensure they can provide high-quality care. It follows a set of standards to guarantee that patients receive the best possible treatment from skilled professionals. At One O’Seven RCM, we offer credentialing services for nearly all specialties across every state in the USA. The process starts when healthcare providers submit their applications, which include details about their education, training, work history, and certifications. This application is the first step in evaluating their qualifications. We provide tailored credentialing services designed to meet the needs of healthcare providers, ensuring a smooth and stress-free experience. Since credentialing can be time-consuming and requires consistent follow-ups, we’re here to handle the heavy lifting, so you don’t have to.

Securing Contracts & Fee Schedules: The final step involves obtaining contracts and fee schedules, which allow you to bill for reimbursements. If needed, we negotiate reimbursement rates with payers. Our team ensures you receive contracts on time so your practice can start billing without delays.

Monitoring & Recredentialing: The process doesn’t end with securing contracts. We continuously monitor expiration dates of documents and keep you informed of any new requirements from payers to maintain compliance. Our automated system tracks expiration dates, and our team ensures you stay updated and compliant.

Collecting Documents: The credentialing process begins by gathering necessary documents from healthcare providers to determine which insurance plans they qualify for. These documents may include certifications, licenses, work history, logins, NPI (National Provider Identifier), identity verification, and more.

Verifying Documents & Managing Provider Portals: Accurate documentation ensures a faster credentialing process with no delays or rejections. Our experts at One O’Seven RCM thoroughly review all documents before submitting them to insurance panels to prevent any issues. We also manage provider profiles on portals to speed up claim processing.

Submitting Documents to Insurance Panels: Once all documents are carefully reviewed, we submit them to the insurance panel. Proper submission is critical for quick approvals and smooth enrollment.

Follow-ups: Submitting documents is just the beginning. Regular and timely follow-ups with payers are essential to track the status of applications. If any issues arise, our team addresses them immediately. We keep you updated on your application status at least twice a month.

NPI Registration for both Type 1 (individual) and Type 2 (Group)

• CAQH Profile Management
• IPA (Independent Practice Association) Enrollment
• ERA (Electronic Remittance Advice) Setups
• EFT (Electronic Fund Transfer) Enrollment
• EDI (Electronic Data Interchange) Setups

Count on Our Trusted Expertise

One O’Seven RCM Ensures you that your practice’s credentialing is always up-to-date so you can deliver best patient care. By choosing us for your credentialing process, you will have:

• Dedicated team
• 24/7 Customer support
• Regular & Timely updates
• Transparency
• Faster Approvals
• Efficient Management
• Compliance
• Revenue Growth