FAQs
What is provider enrollment?
What is primary source verification?
Primary source verification ensures the validity of credentials like licensure and education by verifying their original sources. Healthcare facilities conduct this process to evaluate providers’ qualifications for granting privileges. Credentialing validates providers’ competence to deliver quality care within legal and regulatory frameworks, adhering to state laws, regulatory standards, and organizational policies. This meticulous process is critical for maintaining client safety and organizational licensure integrity.
Our expertise spans Credentialing, Enrollment, Medical Coding, Medical Billing, and Revenue Cycle Management across diverse specialties and organization types nationwide.
What are the benefits of enrolling with an insurance company?
The decision whether to become an in-network provider for local payers is an important one for any provider. And like anything else, organizations must consider the pros and cons of obtaining and maintaining in-network provider status.
One important benefit to becoming a participating provider with an insurance company is an increase in referrals, and in essence, your revenue. As an in-network provider, the organization becomes listed in the payer’s provider directory, that which potentially generates an entirely new client base.
Individuals who have insurance coverage, more often than not, will seek an in-network provider in order to maintain lower out of pocket expenses. In addition, the insurance company itself, will direct patients to your practice via any individuals who call their insurance carrier for recommendations. Thus, a benefit for becoming a participating provider is the opportunity to obtain new patients for your practice.
Once the contract is generated, the rates are negotiable. You are not tied to the rates that they offer off the bat! Once, the rate is agreeable to the provider and if the rate offer makes sense for your organization, there is also the benefit of predictability of reimbursement. This makes for much easier financial planning and budgeting. Once an organization makes the final decision and agrees to the terms of the contract offered, and the offer is accepted, being in-network may simplify the complex claims process because billing would be governed by the terms of one mutually agreed-upon contract.
Why outsource my credentialing?
What services does Apaana provide?
At Apaana we provide a 360° Service Suite across:
Credentialing | Enrollment | Medical Coding |Medical Billing | Healthcare Management Solutions | Revenue Cycle Management across organization types and most specialties.
We have worked with Individuals building healthcare organizations, Established practices start-ups across many states.
Will we have the access to an application tracking system?
Yes, Apaana-PULSE®, our analytics engine gives you the real-time status of your service requests with us. Additionally, Apaana specialists are available and happy to meet with you as frequently as needed.
How long does the credentialing process take?
Credentialing typically spans 90-180 days, varying based on the insurance panel. Delays often occur with private payors if National Healthcare Databases like CAQH aren’t current. Updating or creating profiles is crucial and a common cause for delays. Once payor panels are chosen, onboarding starts. Applications are meticulously prepared and submitted, with rigorous follow-up ensuring swift approval through Apaana’s expertise in payer processes.
Does Apaana have experience in credentialing providers in my area?
We provide nationwide credentialing services!
No matter where your practice or facility is located, our team possesses the expertise to effectively credential and enroll healthcare providers,. From chiropractors to anesthesiologists to surgeons, we ensure thorough and professional credentialing across a wide range of specialties.
Do you do any pre-work for our service request?
Yes, depending on the services chosen from our 360° services suite.
We ensure that the breadth and depth of the practice is understood while building profiles in our systems.
For credentialing & enrollment besides conducting a verification process, we connect with the insurance panels for panel status and begin preparing applications. As requirements are insurance and state specific, there is no time wasted with this approach.
If the panels are closed, we ensure you are enrolled out of network, such that the billing process can be initiated.
Does Apaana specialize in medicare and medicaid enrollments?
Yes, we do and not only that we are specialists in credentialing | enrollment with medicare and medicaid advantage plans.
Additionally, we are well versed and experienced across private commercial payers for your credentialing, enrollment and re-Credentialing needs.
