Credentialing, Contracting and Enrollment

Facility and Provider credentialing, contracting and enrollment is essential to every healthcare organizations and providers. It not only ensures payment for services rendered, but it also instills trust with your patients and shows your willingness to stay in compliance with the federal and state laws.

How can we help?

Island Provider Services can alleviate the headache of completing the necessary paperwork to have you and your practice enrolled, credentialed and contracted with the insurance companies you'd like to bill for your services.

 

  • We will provide you with the facility and / or provider credentialing checklist to ensure we have all of the requested documents. The checklist will be specific to your specialty and state.

  • If you do not already have a CAQH (Council for Affordable Quality Healthcare), NPPES (National Plan & Provider Enrollment) or PECOS (Provider Enrollment, Chain, & Ownership System) account, we will create and maintain your account. Having a CAQH account removes the headache of constantly sending the same information and paperwork to the different insurance companies. Think of CAQH as your one stop location for all required documents.

  • Once all paperwork as been reviewed for accuracy, we will begin the process with the insurance companies for your enrollment, credentialing and contract.

  • Once your paperwork has been approved, you will receive a provider ID number that is specific for the insurance company.

  • You will be able to start billing for the services you provide to your patients.

  • Re-credentialing is necessary with each insurance. This can be done yearly or every two years depending on that insurance. The only time you would need to provide new documents, is if you're making any changes or reassigning any of your benefits. Otherwise, you only need to attest the information is still current with no changes.

Required Information to Provide:
Personal Information:
  • Name: Previous / Other Names

  • Date of Birth

  • Address: Current / Prior

  • SSN

  • Contact Phone Numbers and Emails

Professional Information:
  • Accreditation Letter / Certificate

  • CMS Certification or Accreditation (if you have one)

  • Facility / Department Description / Flowchart

  • Federal Tax ID #

  • General Liability Insurance

  • Malpractice Insurance

  • Medicaid Provider # (if applicable)

  • Medicare Provider # (if applicable)

  • NPI#

  • Professional Liability Insurance

  • State Medical License

  • State Tax ID#

  • W9​​​

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Credentialing Process