Credentialing

Clean and precise credentialing sets the stage for clean claims and reimbursement for services. New providers, experienced providers joining new entities, providers who have decided to form a new practice—all need credentialing. Credentialing is the process of registering the provider and entity’s identifiers and qualifications with the payers.

Meticulous attention to details and consistent provider and practice profile data across all payers are key in avoiding unnecessary confusion at the payer level, delays in reimbursement, and out out-of-network penalties or denials. Not only does the provider need to be credentialed with the payers they wish to work with, but the entity or practice tax ID must also be credentialed. Credentialing is followed by contracting for reimbursement rates.

From that point on, it the appropriate groundwork of policies and procedures must be put in place to set the stage for Revenue Cycle Management. This is an ideal time to consider choosing Quantum Practice Management to handle all your billing and revenue cycle needs. Our highly skilled and specialized billing team is prepared to step in to properly capture all revenue and ensure that they don’t leave money on the table. Our talented receivables management specialists are available to work to maximize cash flow with careful analysis of unpaid claims and aggressive pursuit of all outstanding accounts receivable balances. Give your new practice an edge on the critical start-up phase by working with Quantum Practice Management, Inc.