Credentialing Services

Credentialing is the process of linking physicians with numerous Insurers or Government agencies. Before a physician can bill for his/her services, they first have to be approved by the insurer and issued a national identifier billing number. This process is labor intensive and requires a complete history of the physician's education background and a detailed resume of all activities performed by the physician since graduating from Medical School.

 


Complete Third Party Initial &
Recredentialing Applications

In many cases is it preferred or even required to have credentialing done by a third party source. Group J provides physicians and healthcare facilities complete credentialing services. We process and file documents for:


  • Hospital Privileging
  • DEA/CDS Registration
  • Government Enrollments
  • Education/Residency/Board Certification
  • Health Plans Credentialing
  • Internship & Fellowship
  • State Applications
  • Malpractice Insurance
  • CAQH
  • Malpractice Claims History
  • License Renewals
  • NPDB Query
  • Primary Source Verification

 


 

Group J completes all initial and re-credentialing applications. We will mail/transmit the application to third party payers and/or affiliations. We then follow-up with payer/affiliation to ensure receipt of application. Group J will maintain communication throughout the credentialing process with payers/affiliations and regularly reporting to clients for each entity at client-determined intervals. We conclude with confirmation of participation/privileges communicated to clients concurrently.

 

By outsourcing your credentialing process, you will free up your staff from using a large amount of time filling out unmanageable credentialing or re-credentialing applications. Group J will ensure filing or recredentialing deadlines are not missed. Group J provides credentialing and recredentialing services for all insurers. We also offer services for Hospitals and Hospital Systems, Home Health Agencies, Managed Care Organizations, Medical Staff Offices, MIS Directors, MSOs, Outpatient Surgery Centers, Payer Sponsored Networks, Provider Sponsored Networks, Provider Relations Managers, Physician Networks and Clinics.

 

Medicare/ Medicaid Registration (Enrolling in PECOS System)

There has been substantial confusion over when Medicare's requirement that all physicians who refer their patients, be enrolled in the Medicare enrollment database known as the Provider Enrollment, Chain and Ownership System (PECOS). The Centers for Medicare and Medicaid Services (CMS) announced earlier this spring that all ordering / referring physicians would have until January 3, 2011 to become enrolled in the PECOS system. The confusion over when referring / ordering physicians must become enrolled in the system began when CMS changed the enrollment deadline.

 

Group J can make the process of enrolling or re-enrolling smooth and efficient. Once enrolled we will make sure the physician's submissions are compliant will all PECOS regulations. We are aware of all changes in CMS regulatory changes and will keep your claims up-to-date, reducing delay in payment and maximizing the amount paid.

 

Electronic Submissions of Applications

Unless otherwise specified by the regulatory agency, all credentialing applications are submitted electronically. This provides the fastest and most accurate path to acceptance of the application. It also provides the ability to track the status of the application making the process more transparent. Group J will provide updated reports to clients on the status of their credentialing process through completion.

 

NPI (National Provider Identification) Registration

Group J can process and submit your NPI registration. The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.