The Importance of Revalidation & Credentialing for Groups & Providers

Medical providers must undergo revalidation and credentialing updates on a regular basis with their insurance carriers to stay current with the latest requirements regarding state and federal guidelines. This process also provides the insurance carriers with the latest information pertaining to their organization so that an active and accurate database of information can be kept on file. The insurance carriers require that all Medical groups and providers go through this process every few years in order to ensure that the correct information on file is maintained.

It is imperative that you do not ignore these requests because a lack of compliance will result in the deactivation of your billing numbers; and, without active provider numbers, a practice will not receive payment. Please note too, that if your number becomes deactivated it may take up to 90 days for reinstatement, impacting your bottom line even further.

Medical Healthcare Solutions, Inc. (MHS) offers complete provider insurance revalidation services as well as comprehensive provider enrollment and credentialing services for initial enrollment. It is crucial to work with a team backed by many years of experience in working with the major commercial carriers such as multi-state Medicare, Medicaid, and Blue Shield, among others. For instance, per Mass.gov, Medicare requires that all providers must revalidate every five years;  and submission of that application must occur within 45 days from the date on the revalidation notice.

Consistent Database

The main advantage of revalidation is to maintain an accurate and timely record of all provider and group information to speed up the process of claims and other medical billing tasks. Credentialing involves the review and validation of the professional qualifications of physicians who apply for participation in select insurance networks. This process is designed to ensure all participating providers meet their strict professional standards, thereby ensuring patients get the highest quality medical attention possible by qualified doctors and other providers.

Many medical billing companies provide complete credentialing services, which include assessment of the requirements by carrier, completion of the application(s), submittal to the carrier(s), and follow-up for processing by carrier(s). A database is then maintained by the billing company to keep track of those records across the board.

Switching hospitals or affiliations? Simply contact your medical billing company to prepare the right letters and forms for you to fill out. In addition, providers must submit credentialing change forms if there are any other changes to their enrollment information such as:

  • Legal business name
  • Practice location (change or addition)
  • Ownership
  • Authorized or delegated official
  • Changes in payment information
  • Legal actions

This is a crucial step in maintaining an accurate profile with your insurance carriers.

Insurance revalidation services work in much the same way. Your medical billing company will help you fill out the paperwork, submit the application and provide all necessary forms. MHS, your trusted provider of cooperative billing, has extensive experience working with a variety of software platforms with the ability to interface with all electronic medical records.

Contact Us

If you are sent a revalidation letter or credentialing request, contact Medical Healthcare Solutions, Inc. (MHS) right away to get going on your application. It’s important to get this information submitted as soon as possible to avoid payment interruptions.

Please contact us today to learn more information on how we can help with your revalidation and credentialing needs. We are proud to have decades of medical billing experience and service to the healthcare community under our belts and look forward to assisting you today!

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