Medical Credentialing Services

Medical Credentialing Solutions for Modern Healthcare

Physician credentialing involves the meticulous verification and assessment of a physician’s qualifications, training, experience, and licensure to ensure compliance with healthcare standards.

At Lowkia, we offer customized provider credentialing services designed to meet the unique needs of healthcare organizations. Our comprehensive solutions include automated verification, real-time updates, and dedicated support, streamlining your operations and ensuring accuracy and compliance, ultimately saving you valuable time and resources.

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Comprehensive physician credentialing services by Lowkia

Our credentialing team offers expert and comprehensive services to assist you in becoming an in-network provider with your desired insurance carriers. By performing detailed analyses of your specialty and service area, we provide tailored recommendations, ensuring seamless integration and maximizing your participation opportunities.

Medicare and Medicaid Enrollment Assistance

We specialize in assisting healthcare providers with Medicare and Medicaid enrollment, enabling them to serve eligible beneficiaries under the government programs. Our comprehensive enrollment services ensure providers meet all regulatory requirements, facilitating smoother access to quality care for those in need.

NPI Registration Services

We manage the registration process for National Provider Identifier (NPI) numbers, including Type I for individual providers and Type II for organizations, ensuring seamless and efficient identification necessary for billing and claims.

DMEPOS Enrollment Solutions for Medicare Providers

Our services guide durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers through the enrollment process, ensuring they can offer these specialized products and services to Medicare beneficiaries.

Contract Negotiation Services

With our expertise, we assist providers in negotiating contracts with insurance payers, ensuring they achieve the best terms and conditions, maximizing reimbursement rates, and reducing administrative burdens.

State Licensing for Providers

We offer comprehensive assistance to healthcare providers in securing and renewing state licenses, ensuring full compliance with the regulations necessary for medical practice and healthcare service provision in various jurisdictions.

Credentialing Services for Commercial Insurances

Our team assists healthcare providers in navigating the complex process of commercial insurance credentialing, ensuring they can participate in insurance networks and receive timely reimbursement for their services.

Professional CAQH Registration Services

We facilitate the registration and ongoing maintenance of your Council for Affordable Quality Healthcare (CAQH) profile, ensuring a streamlined provider data collection process for participating health plans. By managing your CAQH registration and updates, we help you maintain compliance and simplify interactions with various healthcare networks.

Securing Hospital Privileges

We facilitate the process for healthcare providers to secure hospital privileges, allowing them to admit and manage patient care at affiliated hospitals. This service extends their practice capabilities and improves patient outcomes.

DEA Certificate & Renewal Services

We manage the application and renewal processes for Drug Enforcement Administration (DEA) certificates, ensuring healthcare providers can prescribe and handle controlled substances as needed for their specialty.

Revalidation and Credentialing Renewal Services

We assist healthcare providers with the revalidation and re-credentialing process, ensuring continuous compliance with regulatory standards and keeping their status active with insurance payers.

Key Benefits of Our Comprehensive Physician Credentialing Services​

We ensure our comprehensive physician credentialing services deliver key benefits, including regulatory compliance, enhanced provider reputation, and streamlined administrative processes. By offering efficient verification and ongoing support, we enable healthcare providers to focus on patient care while maximizing operational efficiency and reimbursement potential.

Minimize Risk, Maximize Revenue:

Avoid the frustration of insurance follow-ups and prevent revenue loss. Our skilled credentialing services ensure you remain efficient and profitable.

Enhance Patient Referrals

Our efficient credentialing process helps you attract more patients and increase referrals. Unlock growth potential and watch your practice thrive.

Personalized Customer Interaction

Benefit from having a dedicated project manager who will guide you every step of the way. Our award-winning customer service guarantees you receive exceptional care.

Quick Payment Solutions

Optimize your cash flow with Lowkia's expedited provider credentialing services, enabling faster payment receipt and smoother financial operations.

FAQ

Medical credentialing ensures healthcare providers meet standards of competence and professionalism, ensuring patient safety and quality care. It verifies qualifications and licenses, enabling providers to participate in insurance networks, receive reimbursements, and enhance the trust and reputation of healthcare organizations.

Medicare enrollment applications typically take between 60-90 days to complete, though this can vary significantly by state. The effective date for Medicare is set as the date the application was received, allowing providers to retroactively bill for encounters that occurred between the application and approval. Additionally, there is a 30-day grace period, enabling providers to bill for services rendered up to 30 days prior to their effective date.

For DMEPOS suppliers, the turnaround time is longer. Due to the thorough scrutiny each application undergoes, suppliers are also required to participate in a site visit as part of the application process. The site inspector ensures the office is located at the address listed on the application, verifies hours of operation, checks where inventory is stored, and reviews other crucial elements of being a DME supplier.

Medicare enrollment revalidation is required every five years, and every three years for DMEPOS suppliers. Individual providers can complete the CMS-855I paper application or use PECOS online. Groups or suppliers need to complete the CMS-855B application and set up an EFT if not previously done. Providers must respond to the revalidation letter within 60 days to avoid termination of billing privileges.

Physician credentialing is the process of verifying a healthcare provider’s qualifications, credentials, and work history to ensure they meet the standards set by regulatory bodies, healthcare organizations, and insurance companies.

Typically, the required documents include:

  • NPI Number
  • CAQH profile (up-to-date)
  • Practice information (Address, etc.)
  • Medical License
  • DEA license (if applicable)
  • License to practice and primary source verification
  • License history
  • Insurance information
  • Education: degrees and transcripts
  • Board certification
  • Detailed work history
  • References (previous employers/practitioners)
  • Malpractice claims history (revocations, suspensions, etc.)
  • Malpractice insurance
  • Insurance login details (Medicaid, Medicare (Pecos), Availity, etc.)

Yes, a service location is essential for credentialing. Insurance companies require providers to have a physical location to deliver healthcare services and to verify their presence in the community. You’ll need to provide the address and contact details during the application process to ensure accessibility for patients and eligibility for credentialing.

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