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Local Phone Number: 210-910-4348 | Toll- Free Number: 888-721-8348

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Credentialing and Enrollment

The current credentialing system is a maze that is highly technical and extremely complex, making it an ongoing nightmare to navigate through. Every state, hospital, and insurance or health plan have different rules, forms, procedures, processes, and requirements for provider enrollment and credentialing, which fluctuates largely with new regulations.

When it comes to getting providers enrolled faster with payors, SimpliCompliance is the partner you can count on! With the full knowledge that every medical practice begins and ends with provider enrollment, SimpliCompliance is continuously monitoring changes with commercial payor credentialing within Medicare/Medicaid guidelines to ensure we stay ahead of the curve. As your trusted partner and in-house virtual credentialing team, we know that these updates are vital for you in maintaining revenue streams, as well as providing optimal health care to your patients. That is why we make your compliance with these regulatory changes our #1 priority!

Our credentialing experts work day and night to get you credentialed faster, so you can see patients sooner with less stress over paperwork.

After doing this for so long, we have direct contacts with insurers and hospitals, who keep us informed on the status of each application submitted. SimpliCompliance’s thorough understanding of the detailed requirements by payors, coupled with our proprietary tracking system and software ensures success with every credentialing project. As our partner, we will communicate with you throughout the process and also help you investigate and resolve any of your credentialing-related claims issues.

Our Solutions Include (customizable to meet your needs):

  • Credentialing and Enrollment with health plans or payors:
    • Preparation & submission of applications to commercial payors
    • Enrollment with Federal Health Plans – Medicare, Medicaid, Tricare etc.
    • Follow up with insurance networks until the credentialing is approved
    • Appeal on Panel Closed Networks
    • Validation of CAQH profile (setup of CAQH Account if no profile exists)
    • NPI Registration and Updates (NPPES)
    • Experienced Credentialing Expert to act as your liaison with the insurance companies
  • Hospital Credentialing / Privileges / Medical Staff Appointments
    • Preparation & submission of applications to area hospitals
    • Follow up with hospitals until privileges are granted
  • Other Credentialing Services:
    • Medical License Application
    • DEA Application
    • CDS Application
    • CLIA Certificate Application
    • Other Facility Certificates
  • Yearly Maintenance Program:
  • Recredentialing with contracted health plans / payors
  • Recredentialing with hospitals and healths systems
  • CAQH attestation and updating of expiring documents
  • NPI Registration Updates (NPPES)
  • Medicare Revalidation
  • Medicaid Revalidation
  • Licensure and certificate monitoring and renewals
  • NPDB Continuous Monitoring
  • And many more.

Alternatively, we can train your Office Manager to perform the Yearly Maintenance Services. Contact us for more information on our Credentialing Solutions and Maintenance Plan for Ongoing Credentialing Support. Our experts are ready to help!