Credentialing & Enrollment Services

DISCOVER NEW POSSIBILITIES WITH OUR CREDENTIALING AND ENROLLMENT SERVICE

Omni Medical Billing is a leading provider of medical credentialing services, streamlining administrative tasks and maximizing efficiency. Our outsourced credentialing solutions remove the burden of paperwork, facilitate in-network participation, and speed up reimbursements. By leveraging our expertise, physicians, nurses, and therapists can focus on their practice and achieve professional success. Join the growing number of healthcare professionals benefiting from our comprehensive doctor credentialing and enrollment services.

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Streamlining Credentialing with Ai Automation

Ai simplifies and accelerates credentialing processes by automating verification tasks, cutting processing times by 50% and ensuring compliance with payer standards.

1st Class Reimbursement

Enjoy the advantage of first-preference reimbursement rates, maximizing your financial rewards. This means you get paid more for the same services, increasing your profitability and satisfaction.

Maximum Privileges

Our streamlined approach not only wins you contracts but also secures vital privileges. You will be able to participate in innovative programs, as well as get incentives for quality performance.

Billing-Ready

You'll be prepared to bill from day one, saving you precious time. You will receive a unique provider identification number (PIN) that allows you to submit claims electronically and track them online.

Swift Reimbursement

Faster reimbursements ensure a healthy cash flow for your practice. You won't have to wait for months to receive your payments, as we process claims within 15 to 30 days on average.

Payer Support

Our advocacy ensures insurance companies stand by you, supporting your needs. We negotiate on your behalf and resolve any issues that may arise, ensuring you get paid fairly and promptly.

Minimize Denials

With our expertise, denials become a thing of the past, boosting your efficiency. We verify eligibility, obtain authorizations, and submit accurate claims, reducing errors and rejections.

SAVE UP TO 80% ON STAFFING WITH OUR CREDENTIALING AND ENROLLMENT SERVICES

Omni Care Medical Billing provider enrollment services unlock in-network contracts, no matter how exclusive the payor panel.

Omni Care Provider Credentialing Services

We Enroll Providers In Premium Payer Networks In Record Time!

Credentialing, also known as insurance or provider credentialing, is a crucial process that verifies the qualifications, skills, and legitimacy of healthcare providers. This ensures that providers have the required licenses, certifications, and education to deliver healthcare services to patients safely and effectively.

Only credentialed providers are eligible to receive payments from payers and operate in compliance with both state and federal regulations. Medical credentialing allows physicians to practice in specific facilities and be accepted into insurance networks such as CMS/Medicare, Medicaid, Aetna, Cigna, Humana, UnitedHealthcare, and Blue Cross Blue Shield.

As a provider, swift credentialing is essential to start practicing and billing both legally and ethically. However, the credentialing process is complex, requiring extensive documentation and multiple stages of verification by insurance networks. Even a minor mistake can lead to denials, causing delays and unnecessary costs.

Omni Medical Billing offers top-tier credentialing solutions, taking the burden off your shoulders. Our expert team manages everything from primary source verification to enrollment in leading payer networks, all while ensuring a timely and cost-effective process.

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Our Medical Credentialing Process

A Walkthrough of Our Specialist-Vetted Provider Credentialing Process

Omni Medical Billing’s provider credentialing process goes beyond being a routine task—it’s a thoroughly validated and certified approach that guarantees top-tier compliance standards. We have achieved up to a 98% success rate in securing provider approvals within premium payer networks, ensuring they receive the maximum privileges in their respective specialties. Our credentialing process typically involves the following key steps:

Surveying the provider

Our credentialing process begins with an in-depth survey conducted by our credentialing specialists. This process involves comprehensive interviews with providers, gathering essential data such as license numbers, educational history, demographics, and professional background.

Choosing the insurance company

Our medical credentialing services guide providers in strategically choosing insurance partners aligned with their practice goals and license type, while also finalizing insurance panels based on practice location.

CAQH Enrollment and Management

We take care of CAQH application submissions, manage ProView accounts, and keep credentials current for smooth primary source verification. We also assist with payer credentialing submissions, ensuring quick insurance panel integration and accurate profiles that enhance network engagement and the quality of patient care.

Ensure Fast Credentialing Approval

Although the typical timeline is 60-120 days, our provider credentialing experts take proactive steps to accelerate the process. Our team engages in weekly interactions with payers, advocating for the rapid processing and endorsement of your credentialing applications.

In-Network Enrollment

Upon completing credentialing, your application enters the contract phase. Here, an in-network contract may be offered, including fee schedules and eligible CPT billing codes. We handle closed panel challenges, advocating through appeals to secure your inclusion. With successful credentialing, direct billing becomes feasible, often with preferred reimbursement rates for in-network providers.

Winning you Hospital Privileges Application

As credentialing wraps up, our active involvement persists. We assist you in gaining all necessary hospital privileges: whether it’s admitting, courtesy, or surgical rights.

Ongoing Monitoring and Updates

Our continuous oversight ensures that your company’s credentials remain current and that you stay credentialed without interruption. Our experts diligently track your credentialing expirations and conduct comprehensive daily and weekly reviews to maintain your active status. You can rest easy knowing that your credentials are in good hands with us.

Complete Provider Credentialing Solutions

Helping Health Care Providers With All Their Credentialing Needs

Omni Medical Billing offers comprehensive provider credentialing services for healthcare professionals and organizations. Here’s a summary of the medical credentialing and enrollment solutions we provide:

Medicare and Medicaid Provider Enrollment
We facilitate the enrollment of healthcare providers in Medicare and Medicaid, two of the largest health insurance programs in the U.S., covering millions of Americans. By becoming part of these programs, providers can expand their patient base, boost revenue, and ensure compliance with federal and state regulations.

Commercial Insurance Credentialing
We assist providers in obtaining credentialing with major commercial insurance companies like Aetna and Humana. Credentialing with these private insurers allows providers to reach a broader patient base and negotiate favorable reimbursement rates.

NPI Registration (Type 1 and Type 2)
Our credentialing services support individual providers (Type 1) and healthcare organizations (Type 2) in obtaining and managing their National Provider Identifier (NPI). This unique 10-digit identifier, assigned by the Centers for Medicare & Medicaid Services (CMS), is essential for billing, reporting, and conducting electronic healthcare transactions.

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CAQH Registration and Profile Management
At Omni Medical Billing, we help healthcare providers stand out from the competition. Our credentialing experts handle the complete registration and maintenance of every provider’s profile on the Council for Affordable Quality Healthcare (CAQH) ProView. This online platform collects and verifies provider information for credentialing purposes. By utilizing CAQH ProView, providers can streamline their credentialing process with multiple health plans efficiently.

Medicare DMEPOS Enrollment
With our credentialing services, providers can easily enroll in the Medicare DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) program. This program covers essential items like wheelchairs, oxygen equipment, braces, and diabetic supplies. Through enrollment, providers can offer these items to Medicare beneficiaries, enhance their level of care, and secure Medicare reimbursement.

Hospital Privileges Management
Omni Medical Billing also assists physicians in acquiring and renewing hospital privileges, which are essential rights granted by hospitals to practice within their facilities. With hospital privileges, providers can admit and treat patients, utilize hospital resources, and work collaboratively with other healthcare professionals.

Contract Negotiation
Our credentialing team supports doctors by negotiating contracts with insurance payers, outlining the terms and conditions of the provider-payer relationship. Through effective negotiation, healthcare providers can secure better payment rates, establish clear dispute resolution processes, meet quality standards, and ensure network inclusion.

Revalidation & Re-Credentialing
Omni Medical Billing oversees the entire revalidation and re-credentialing process for every physician, ensuring compliance with Medicare, Medicaid, and commercial insurers. With our automated management system, providers can maintain their eligibility in these programs, avoiding disruptions or penalties.

Reimbursement Issue Audits
Our credentialing specialists thoroughly audit reimbursement issues, such as underpayments, denials, delays, or errors from insurance payers. We also provide accounts receivable (AR) follow-up services to assist in collecting outstanding payments. By auditing reimbursement problems and managing AR, providers can enhance cash flow, reduce bad debt, and optimize their revenue cycle.

Payer Enrollment and Medical Credentialing for Doctors

Credentialing and Payer Enrollment Services For All Healthcare Organizations

Proper credentialing is essential for healthcare providers to deliver quality care, attract patients, and maintain compliance. Our comprehensive credentialing service helps providers of all specialties navigate these challenges. Our payer enrollment credentialing services are available for:

Physicians


Our credentialing service ensures physicians gain swift access to insurance networks, accelerating patient care. It’s crucial for maintaining credibility and trust with patients and peers.

PAs/NPs

Credentialing via our service aids PAs/NPs in expanding their practice reach, ensuring they’re authorized to deliver essential medical services independently.

Hospitals

Credentialing with us streamlines hospital operations, enabling efficient insurance claims processing and fostering collaboration among medical staff.

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ERA (Electronic Remittance Advice)

Omni Care Medical Billing offers Electronic Remittance Advice (ERA) services to streamline payment posting. With ERA, healthcare providers receive detailed payment information electronically, allowing for faster reconciliation of claims and improved efficiency in managing accounts receivable.

EDI (Electronic Data Interchange)

Our Electronic Data Interchange (EDI) services ensure seamless communication between healthcare providers and insurance payers. By automating the exchange of claim submissions, eligibility verification, and payment information, Omni Care Medical Billing helps reduce errors, speed up claim processing, and enhance overall operational efficiency.

 

EFT (Electronic Funds Transfer)

Omni Care Medical Billing simplifies payment processes through Electronic Funds Transfer (EFT) services. EFT enables providers to receive payments directly into their bank accounts, reducing processing time, improving cash flow, and ensuring timely reimbursement from payers.

Enroll With Your Favorite Payer Through Omni Care Medical Billing

Government Payers

Examples include – Medicare, Medicaid, and TRICARE.

Commercial Payers

Examples include – Blue Cross Blue Shield, Kaiser Permanente, Anthem, United Healthcare, Aetna, Cigna, and Humana

Don’t let the red tape stop your pace.

Credentialing can be a hassle, but not with us. We have the skills, the tools, and the connections to get you credentialed and enrolled with any payer you want. No matter what your specialty or location, we will enable you enjoy the benefits of being in-network!