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Frequently Asked Questions

Can you help me enroll in just one plan?

Yes. We have individual pricing available for providers or practices who want to add additional plans.

Can you help me obtain a group NPI?

Yes. We can help you apply and obtain a group NPI for your new or established practice.

Can you help me with hospital privileges?

Yes. We can complete your application and follow-up with your hospital to ensure that your privileges are granted in a timely manner.

Can you help with my CAQH application?

Yes. If you do not have a CAQH ID we can help you obtain one in the credentialing process. We will complete this application for you and ensure that it is correct and submitted correctly to your insurance plans.

Can you suggest plans to enroll?

Yes. Please contact us today for a personalized quote and we will work with you to identify the best plans for your practice in your area.

How often do I need to be Recredentialed?

It is important to maintain all of your credential information as it changes. In addition, you should re-attest your CAQH application every 60-90 days. Insurance companies will typically re-credential providers every 18 months.

I am a large practice how can MDCredentialing help me?

We can eliminate your need for a credentialing specialist in your practice. The cost associated with having an employee on your payroll includes not only their salary but health insurance, retirement, facilities and equipment. If you already have an employee who is responsible for these duties they can be reassigned to another area of the practice.

I am a new practice how can MDCredentialing help me?

We can contract and credential your practice and providers. In addition we can suggest plans available in your area and help you with new practice start-up options.

I am a new provider who just completed my residency/fellowship how can MDCredentialing help me?

We can help you apply for your license, DEA, CDS, etc in your new state of practice. In addition we can help you enroll in the proper insurance plans for your new practice.

I am a provider in an academic practice how can MDCredentialing help me?

Though most academic practices delegate their credentialing at the University level, we can help you with your application for hospital privileges, licensing, DEA, etc.

I am a small practice how can MDCredentialing help me?

We can credential and contract your providers as well as maintain your credentialing information. Special attention is needed throughout the credentialing and contracting process and most small practices don’t have a dedicated credentialing employee to manage these issues.

I am relocating how can MDCredentialing help me?

We can help you apply for your license, DEA, CDS, etc in your new state of practice. In addition we can help you enroll in the proper insurance plans for your new practice.

I have an established practice who is already contracted how can MDCredentialing help me?

We can help you add additional plans that you may not be currently enrolled with as well as maintain your current information. You should re-attest your CAQH application every 60-90 days and insurance companies will require re-credentialing every 18 months.

What is Contracting?

Contracting - the second step to becoming an in-network provider is to contract with the insurance carrier.

Contract Negotiation
We will review contracts to ensure that they are appropriate for the practice so maximum reimbursement is achieved.

Our contracting representative’s work with practices to understand their specific needs and make recommendations on additional insurance plans that may benefit the practice. We will negotiate your contracts to ensure the best available reimbursement rates are included.

Contract Renegotiation
We will renegotiate current contracts of established practices to attempt to increase their current fee schedule

How can MDCredentialing Help?
We offer full management of both facility and health plan credentialing and contracting. We complete all applications, submit paperwork and perform necessary follow-up for successful credentialing and contracting.

What is Credentialing?

Credentialing is the verification of a provider’s information to ensure that they meet the criteria outlined in the company’s procedure to become an in network provider. Typically this includes primary source verification of the following; License, DEA, CDS, Medical Education, Training Verification, Malpractice History, etc)

Insurance Credentialing
To become an in-network provider with an insurance carrier, providers must first complete the credentialing process. Each carrier may have different criteria and processes.

Facility Credentialing
To have privileges at a facility (hospital, nursing home, dialysis center, etc) providers must complete the credentialing process of each hospital and be approved by their credentialing committee.

What paperwork do you need from me to get started

Please contact us today to request a personalized quote and we will be happy to send you all of the paperwork to begin working with your practice today. This includes our 3 page provider information form as well as attachments needed. (Attachments may include copies of your license, dea, malpractice insurance, diplomas, etc.)

Request a Quote

What services do you offer?

You can view all of the services we offer on our Services page.

What types of providers do you work with?

  • New and Established Medical Practices
  • New and Established Physicians (MD and DO)
  • Nurse Practitioners (NP)
  • Physician Assistants (PA)
  • Chiropractors (DC)
  • Podiatrist (DPM)
  • Behavioral Health Professionals
  • Physical Therapist
  • Occupational Therapist
  • Optometrist
  • Dentist

Where is my data stored?

We store applications, credentialing worksheets, statements, contracts, CPT codes, reports and other information in an electronic format through optical scanning or other technologies on a secure sever.