The process of getting a provider credentialed with a payer involves numerous manual steps, such as completing application forms, providing clarifications to payer questions, and following up to close the credentialing request. With Zephyr Health Management Service, you can keep your data up-to-date with payers by using our Provider Credentialing Services.

Importance of Provider Credentialing

Provider credentialing is the process of getting a physician or provider affiliated with payers. This critical step in the revenue cycle allows patients to use their insurance cards to pay for medical services and enables providers to get reimbursed. It is crucial for healthcare providers to enroll and get credentialed with as many payers as possible. Failure to do so may result in patients seeking competing providers who accept their insurance plans.

Our Credentialing Process

Trust Zephyr Health Management Service to get you credentialed faster. We understand the forms required by each payer and their policies and procedures. Our process includes:

1. Application Evaluation: Completing required documentation and identifying exceptions.
2. Primary Source Documentation: Verifying practitioner/facility information.
3. Outbound Call Center: Obtaining missing documents and updating the payer’s database.
4. Follow-up with Payers: Following up on submitted credentialing requests.
5. Data Entry: Capturing data, labeling, and linking images to specific providers/facilities in the payer’s database.
6. Maintenance of Provider Data: Updating provider information as per policies and procedures, and CAHQ profile.

Provider Enrollment

Our Provider Enrollment services ensure practices are enrolled for the services they provide, enabling payers to process claims efficiently. We monitor payers to ensure applications are received and processed promptly, identifying and resolving potential administrative issues before they impact reimbursements.

The process includes:

1. Verification of Provider Information: Contacting payers to confirm they have the correct provider information before submitting claims.
2. Updating Practice’s Pay-to Address: Validating and updating the provider’s pay-to or billing address.
3. Enrolling for Electronic Transactions: Our team can enroll providers for:
   • Electronic Data Interchange (EDI)
   • Electronic Remittance Advice (ERA)
   • Electronic Fund Transfer (EFT)
   • CSI
4. Monitoring Process: A skilled team performs research and analysis on potential processor functionality gaps.

Benefits of Our Services

Provider credentialing and enrollment services with Zephyr Health Management Service allow you to:

• Keep your data up-to-date with payers.
• Process faster payments from insurance and receive more patient referrals.
• Mitigate revenue leakage.
• Avoid piles of paperwork and application forms.
• Reduce denials and identify provider trends.
• Build relationships with different payers.
• Receive real-time status updates on credentialing and enrollment transactions.

Contact Us

Learn more about how Zephyr Health Management Service’s Provider Credentialing and Enrollment Services can benefit your organization.