Our Comprehensive Credentialing Services
Since 2023, CarePart LLC has helped healthcare providers accelerate credentialing and enrollment. Our proven 95% success rate ensures your credentialing process is completed efficiently, saving you valuable time and minimizing administrative burdens. We offer a comprehensive suite of physician credentialing services designed to meet the needs of specialties of all sizes.
MCR DMEPOS Enrollment
Medicare Carrier Request, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (MCR DMEPOS) enrollment is the process required by Medicare to be allowed to provide these specific products and services and bill Medicare for them. Our credentialing services help you enroll in the Medicare DMEPOS program, so that you can improve the quality of care and receive reimbursement from Medicare.
Commercial Insurance Credentialing
The credentialing process with commercial insurance payers can be lengthy due to
varying eligibility criteria and plan complexities. The process can take several
months before you can start seeing their patients, so we make sure there are no
additional delays due to missing information.
Our expert team gathers and organizes all required documentation, including
licenses, certifications, and training records. We ensure you get credentialed with
commercial insurance payers like Humana, Cigna, and Aetna.
Revalidation & Re-Credentialing
Revalidation and re-credentialing are required over time to ensure continuous compliance and active status with payers. Usually, validation is required every five years, and re-credentialing is required every three years. Our physician credentialing services offer a smooth revalidation and re-credentialing process with Medicare, Medicaid, and commercial insurers. We proactively update your demographics (practice location, contact information, etc.) to prevent any delays or penalties.
CAQH Registration and Maintenance
Our credentialing specialists register and maintain your provider’s profile on the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView). This streamlines the credentialing process with multiple health plans.
Medicare and Medicaid Provider Enrollment
We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. This leads to a wider patient base and, potentially, a lot more revenue for their practices.
NPI Registration (Type 1 and Type 2)
Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.
Hospital Privileges
We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice.
Contract Negotiation
Negotiation is required with each insurance payer to get the most favorable terms and maximum reimbursement rates. Our experienced credentialing team helps physicians negotiate contracts with insurers to get the most favorable terms for their services, payment rates, and network inclusion.
Reimbursement Issues Audit
We conduct thorough audits of reimbursement processes to identify and resolve issues that may be affecting your revenue cycle. These issues include claim denials, underpayments, delays, or errors by insurance payers. Our goal is to optimize your reimbursement rate while minimizing potential revenue losses.
Provider State Licenses
We assist providers in obtaining and renewing state medical licenses. The rules and regulations for issuing licenses to healthcare providers differ by state. Obtaining and renewing state licenses can benefit providers in three ways: compliance, competence, and liability protection.
DEA Certificate & Renewal
All qualified practitioners who write controlled substance prescriptions must hold a federal Drug Enforcement Administration (DEA) certificate. Our healthcare credentialing services include the application and renewal processes for DEA certificates. We enable healthcare providers to prescribe and handle controlled substances according to their specialty.
CLIA Registration
Practitioners and laboratories that perform tests for disease diagnosis, prevention, or treatment must be registered in accordance with the Clinical Laboratory Improvement Amendments (CLIA). We assist healthcare providers with the CLIA registration process, enabling them to provide testing services to patients.
Aggressive Follow-Up
Most insurance plans have a backlog of credentialing applications. CarePart LLC makes sure that your application gets received. We check regularly to see where it is in the process. Our dedicated team maintains a record of all ongoing follow-ups until the application is approved and participation is confirmed.
Compliance with NCQA
Our physician credentialing services comply with the National Committee for Quality Assurance (NCQA) standards. This provides our clients access to preferred partnerships and networks, ultimately expanding your patient base.
Continuous CAQH Monitoring
CAQH requires maintaining up-to-date credentialing information and regularly re-attesting the information in CAQH profiles. When we receive updated insurance, license, or DEA documents from you, our skilled team uploads the new data to CAQH with an updated expiration date. Keeping your records updated prevents re-accreditation delays.
AR Management
and Follow-Up
We provide comprehensive AR management and follow-up services to help hospitals recover lost revenue. Our dedicated team prioritizes aged accounts and uses advanced analytics to identify every opportunity for collection. This is why we have a proven record of reducing AR by 30%.
Denial Management
We manage claim denials systematically with the IMMP process. IMMP stands for Identify, Manage, Monitor, and Prevent. First, we identify the reasons for claim denials. Then, we appeal it and have the insurer pay the claim. Lastly, we reduce future denials by revising processes and retraining staff.
Expert Application Completion
Application errors may result in delays and denials. Our diligent team ensures your application is complete and gets approved the first time it is submitted. We carefully submit your practice address, license, fax, contact information, services provided, and any other records of experience to prevent delays or denials.
Our Credentialing Services Benefit All Kinds of Practitioners
- Hospitals
- Clinical Social Workers
- Registered Nurses
- Podiatrists
- PAs/NPs
- Physical Therapists
- Optometrists
- PT/OT/SLP
- Clinical Psychologists
- Physicians
- Podiatrists (DPM)
- Occupational Therapists
- Marriage and Family Therapists
- Dentists
- Speech-Language Pathologists
- Chiropractors (DC)
- And many more
Which documents are required for insurance credentialing?
- Current CV (including current employer, with all entries in mm/yy format)
- DEA (federal) and state Controlled Dangerous Substances (CDS) certificates
- Malpractice Insurance (Certificate of Insurance)
- Current driver’s license
- Board Certification(s)
- Practitioner License(s)
- Diploma or a copy of the highest level of education (required for non-MDs and DOs)
- Collaborative Agreement (required for Nurse Practitioners)
- ECFMG Certificate (if the provider was educated outside the US)
- Letter of Admitting Arrangement (required for providers who do not have hospital admitting privileges)
- Passport or other citizenship documents (if the provider was born outside the United States and has not previously enrolled with Medicare)
- Letter of Prescribing Arrangement for a physician who does not hold a DEA certificate.
- IRS Form CP575 or substitute letter 147C (EIN verification)
- IRS Form W-9
- CLIA Certificate
- Copy of office lease (required for therapy facilities)
- Business License
- Verification letter of bank account (for Medicare enrollment)
How much time does it take to enroll with Medicare?
What is a CP575?
Which Medicare application is used for provider enrollment?
- Physicians and Non-Physician Practitioners: CMS-855I
- Group Practices, Clinics, and Certain Other Suppliers: CMS-855B
- Institutional Providers: CMS-855A
- Ordering and Certifying Physicians and Non-Physician Practitioners: CMS-855O
- DMEPOS Suppliers: CMS-855S (This form might be undergoing revisions)
Do I need a service location to begin credentialing?
While some exceptions might exist, a home address can be used for billing and correspondence, as long as a physical business address is also provided. This works even if the office is still under construction. The application can be submitted up to 30 days before the location opens for patients. Most commercial carriers have the same policies.
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