Provider And Physician Credentialing Services

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Credentialing is one of the most labor-intensive functions of a physician's practice, as well as one of the more challenging/frustrating aspects of running and/or starting a medical or dental practice. 

However credentialing is the first step to complete prior to submitting medical claims, and must be continuously monitored for renewals.  To most, credentialing is a long drawn out process, filled with completing applications, waiting on hold for provider relation representatives and gathering lots of documentation, and consistent follow up. 

Failing to properly manage the credentialing and contracting process WILL cause loss in revenue.  Studies show it can take up to 30 hours per provider each year to complete the credentialing process. There is also a considerable amount of time required to complete medical & dental plan enrollments, hospital privileges, malpractice applications, license renewals. 

You can see this process is very time consuming for your administrative team, as they need to focus on assisting you with your patients and the day to day operations of your practice. 

No Worries! Diamond Resolution Group can help! We will work with your team to ensure we have the necessary data to properly handle all of your credentialing services in a timely and efficiently manner.  

• Physicians
• NP’s
• Plastic Surgeons
• Acupuncturist
• Chiropractors
• Physical Therapist 
• Occupational Therapist

Enrollment and Physician Credentialing Services we provide: 

• Individual and Group  Applications
• Commercial Insurance Provider Enrollment and credentialing  (ie. Aetna, Anthem, BCBS,    CIGNA, TriCare, Humana, United Healthcare, Many More!)
• Identify all health plans available in the provider’s geographic area
• Letters of intent to join all networks
• Medicare/Medicaid provider enrollment and re-validations
• Private and Managed Care Networks
• Hospital Medical Staff applications: Hospital Privileges
• PECOS
• CAQH Registration
• NPI Registration (Type I and Type II)
• Malpractice Insurance Applications
• Board Certifications
• DEA/CDS Registrations
• Licensure
• Reimbursement Issues
• Managed Care Contracting Issues

New Provider – as a new provider you must be credentialed with insurance plans to include Medicare in order to receive reimbursement for the services you provide. Diamond Resolution Group will help you with your credentialing and contract you with the insurance companies of your choice.

Starting a New Practice – We will help get you credentialed and obtain new contracts under the new tax-id or your social security number. When a provider changes tax-id numbers or you may need to obtain new contracts. If you change states, you must complete the entire credentialing process in the new state. Either way when starting a new practice if you were credentialed previously your credentialing will not follow and you. Diamond Resolution Group will ensure that all of your credentialing for your new practice is completed accurately.  

Adding a New Providers – As your practice grows, and you add associates to your practice, remember most insurance companies will require group contracts for practices with more than one provider. Each provider will need to be credentialed and either added to the group contract, or have an individual contact that will pay to the practice tax-id. Diamond Resolution Group will work with your providers to complete the necessary application and contracts to ensure your practice is paid for services rendered.

New Insurance Company – You may choose to accept new insurance companies at some point.  This requires establishing new contracts, to include making sure your fee schedule is reviewed for the new insurance plans. Diamond Resolution Group, can help you establish all necessary contracts for any plan of your choice and review the fee schedule for the new insurance company.