Credentialing and Contracting

Credentialing and Contracting

Making Credentialing and Contracting Easy for Healthcare Professionals

ZMC simplifies medical staff credentialing services and insurance credentialing for providers, helping healthcare professionals focus on care. We offer hospital credentialing assistance, physician enrollment services, and managed care contracting support. From credentialing verification to provider contract negotiation, we streamline processes to boost reimbursements and ensure fast healthcare provider credentialing results.

Trusted by doctors, nurses, and therapists, ZMC delivers expert healthcare provider credentialing and physician enrollment services. From insurance paneling services to credentialing verification, we support professionals at every stage. Our medical credentialing consulting and credentialing and privileging support help streamline operations, making us a top choice for reliable credentialing and contracting solutions.

Credentialing and contracting services for healthcare providers by ZMC

1st Class Reimbursement

Take advantage of higher reimbursement rates, so you get paid more for the same services. This helps increase your profits and satisfaction.

Maximum Privileges

Our simple approach helps you win contracts and gain important benefits. You’ll have the chance to join innovative programs and earn rewards for great performance.

Billing-Ready

You’ll be ready to start billing from day one, saving you valuable time. You’ll also get a unique provider ID number (PIN) to submit and track claims online easily.

Swift Reimbursement

Faster reimbursements help keep your practice's cash flow healthy. You won’t have to wait months for payments, as we process claims in just 15 to 30 days on average.

Payer Support

We advocate for you, making sure insurance companies support your needs. We handle negotiations and resolve any issues, ensuring you get paid fairly and on time.

Minimize Denials

With our expertise, denials are a thing of the past, improving your efficiency. We verify eligibility, get authorizations, and submit accurate claims, minimizing errors and rejections.

We advocate for providers to gain access to valuable in-network contracts…

ZMC provider enrollment services open the door to in-network contracts, even with the most exclusive payor panels.

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Advocacy for healthcare providers

Collaborate with insurance companies

Secure your place in premium networks

Maximum hospital privileges

Credentialing and contracting services for healthcare providers by ZMC

We enroll providers in top-tier payer networks quickly and efficiently!

Accurate medical coding is crucial, especially with ACA requirements that mandate healthcare providers to give patients a detailed breakdown of services and costs. At ZMC, our certified coders carefully review medical records and assign the right standardized codes, ensuring your claims are processed quickly and fully, without delays from coding mistakes.

We stay updated with the latest coding guidelines and laws to ensure compliance and protect you from audit risks and overcharging due to unbundling. With ZMC, you can count on accurate and timely reimbursements.

Our coders receive thorough training and continuous education, allowing them to handle even the most complex cases, reducing claim denials, and preventing revenue loss.

Outsource your coding to ZMC and have peace of mind knowing your claims are correctly coded from the start. Our affordable services pay for themselves by recovering lost revenue and increasing reimbursements, covering more than the cost of our services.

Our Medical Credentialing Process

A Step-by-Step Guide to Our Specialist-Vetted Provider Credentialing

At ZMC, our credentialing process is built to maintain the highest standards of compliance and efficiency. With a success rate of up to 98% in securing approvals for premium payer networks, we help providers gain maximum privileges within their specialties.

Surveying the Provider

Our experts perform a thorough survey as the first step in our certification procedure. This step includes interviews with providers to gather essential information, such as license numbers, educational history, professional background, and demographic details.

Choosing the Insurance Company

We help providers choose the right insurance partners that align with their practice goals and licenses, ensuring a strategic selection of insurance panels based on the provider’s location and area of specialization.

CAQH Enrollment and Management

We manage CAQH application submissions and ProView account updates, ensuring that credentials are current for smooth primary source verification. Our team also handles payer credentialing submissions to speed up insurance panel integration and ensure accurate provider profiles.

Ensure Fast Credentialing Approval

While the standard process takes 60-120 days, we accelerate the timeline by proactively engaging with payers. Weekly follow-ups are conducted by our staff to guarantee prompt credentialing application processing and acceptance.

In-Network Enrollment

After credentialing is finished, we help with the contracting process. This involves negotiating in-network contracts, securing fee schedules, and tackling closed panel challenges through appeals. We strive to optimize reimbursement rates and guarantee seamless network connectivity.

Winning Hospital Privileges

As the credentialing process wraps up, we also assist in securing the necessary hospital privileges, including admitting, courtesy, and surgical rights, ensuring providers are fully equipped to serve their patients.

Ongoing Monitoring and Updates

We continuously monitor and track credentialing expirations, conducting daily and weekly reviews to ensure credentials stay up to date. Our team handles renewals, giving you peace of mind and ensuring uninterrupted status.

C omplete Provider Credentialing Solutions

Assisting Healthcare Professionals With Every Credentialing Requirement

ZMC offers companies and healthcare professionals complete provider credentialing services. We simplify the process, ensuring compliance, quick approvals, and smooth integration into top-tier payer networks.

Medicare and Medicaid Provider Enrollment

We enroll providers in Medicare and Medicaid, the largest health insurance programs in the U.S., providing coverage to millions of Americans. By joining these programs, providers can expand their patient base, increase revenue, and ensure compliance with both federal and state regulations.

Commercial Insurance Credentialing

In order to gain access to private health plans and networks, we assist clinicians with credentialing with leading commercial insurers such as Aetna, Humana, and others. Providers can increase their patient base and bargain for higher reimbursement rates by becoming credentialed with these insurers.

NPI Registration (Type 1 and Type 2)

Our credentialing services include obtaining and updating National Provider Identifiers (NPI) for both individual providers (Type 1) and organizations (Type 2). The NPI, a 10-digit number issued by CMS, is crucial for billing, reporting, and electronic transactions, ensuring smooth operations for healthcare providers.

Credentialing and contracting services for healthcare providers by ZMC
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Credentialing and contracting services for healthcare providers by ZMC

CAQH Registration and Maintenance

By monitoring their profiles on the Council for Affordable Quality Healthcare (CAQH) ProView, we assist providers in differentiating themselves from their peers. For the purpose of credentialing, this online database gathers and validates provider information.
By using CAQH ProView, providers can streamline their credentialing process across multiple health plans, making it more efficient and effective.

MCR DMEPOS Enrollment

The Medicare DMEPOS program, which covers things like braces, oxygen equipment, wheelchairs, and diabetic supplies, is open to providers that use our credentialing service.
By joining this program, providers can offer these essential items to Medicare beneficiaries, enhance the quality of care they provide, and receive reimbursement from Medicare.

Hospital Privileges

Hospital privileges are the rights that a hospital grants a provider to practice within its premises, and we help doctors get and renew these privileges. Providers can cooperate with other medical professionals, admit and treat patients, and use hospital resources with hospital privileges, all of which improve their capacity to offer complete care.

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Contract Negotiation

In order to negotiate the terms and conditions of the provider-payer relationship, our credentialing team assists physicians in drafting contracts with insurance payers.By negotiating these contracts, medical practitioners can secure favorable payment rates, establish clear dispute resolution processes, ensure quality measures are met, and gain inclusion in insurance networks.

Revalidation & Re-Credentialing

Our medical insurance credentialing service handles every aspect of a physician’s revalidation and re-credentialing process, ensuring their status with Medicare, Medicaid, and commercial insurers remains up to date. With BellMedEx managing these processes on autopilot, providers can maintain their eligibility to participate in these programs without interruptions or penalties.

Reimbursement Issues Audit

Our credentialing and privileging specialists audit reimbursement issues, including underpayments, denials, delays, or errors from insurance payers. We also provide accounts receivable (AR) follow-up services to help collect outstanding payments from payers. By auditing reimbursement issues and managing AR, providers can improve cash flow, reduce bad debt, and optimize their revenue cycle.

Credentialing and contracting services for healthcare providers by ZMC
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Credentialing and contracting services for healthcare providers by ZMC

Providers State License

We help providers obtain and renew their state licenses to practice medicine in the U.S. Each state has specific requirements and procedures for licensing healthcare providers. By obtaining and renewing their state license, providers ensure compliance with state laws, demonstrate their qualifications and competence, and protect themselves from professional liability.

DEA Certificate & Renewal

BellMedEx’s medical credentialing experts assist providers with obtaining and renewing their Drug Enforcement Administration (DEA) certificate, which authorizes them to prescribe controlled substances in the U.S. By obtaining and renewing their DEA certificate, providers can legally and safely prescribe these medications to their patients.

CLIA Registration

Providers using our physician credentialing services receive assistance with registering their laboratory under the Clinical Laboratory Improvement Amendments (CLIA), which set federal standards for laboratory testing on human specimens. CLIA registration is required for any laboratory that conducts tests for diagnosing, preventing, or treating diseases, or for health assessments.

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Credentialing and contracting services for healthcare providers by ZMC

Best Provider Credentialing Services Near Me

ZMC offers The Best Credentialing Services Near You In The USA

Looking for the best credentialing solutions from specialist companies near you? With over a decade of experience, BellMedEx is the top provider credentialing company, serving practices across all 50 states in the USA.

We begin by thoroughly assessing your practice’s specific needs and the requirements of the state and payers you wish to work with. From there, we use our extensive payer contracts and relationships to gather and verify all necessary documents, licenses, certifications, insurance, and more to meet each payer’s unique criteria.

For example, when credentialing a physician in California, we would verify their medical license with the Medical Board of California, check for any disciplinary actions on the National Practitioner Data Bank, review their malpractice insurance coverage, and collect a current CV and diploma. We then submit these documents to health plans like Blue Shield of California and Health Net to ensure a smooth credentialing process.

Additional credentialing services, such as re-credentialing, expediting credentialing, and credentialing for locum tenens providers, are also part of BellMedEx’s comprehensive Provider Credentialing and Enrollment Service offerings.

Payer Enrollment and Medical Credentialing for Doctors

Credentialing and Payer Enrollment Services For All Healthcare Organizations

Proper credentialing is crucial for healthcare providers to offer quality care, attract patients, and stay compliant with regulations. Our complete credentialing service helps providers in all specialties manage these tasks smoothly. We offer payer enrollment and credentialing services for:

Physicians

Our credentialing service helps physicians quickly join insurance networks, speeding up patient care. It's essential for maintaining credibility and building trust with both patients and colleagues.

PAs/NPs

Credentialing via our service aids PAs/NPs in expanding their practice reach, ensuring they’re authorized to deliver essential medical services independently.

Hospitals

Credentialing with us simplifies hospital operations, making insurance claims processing more efficient and promoting better collaboration among medical staff.

PT/OT/SLP

Our credentialing service helps therapists join insurance panels, allowing them to provide essential rehabilitation services while ensuring financial stability.

Podiatrists (DPM)

Credentialing through us helps podiatrists provide specialized foot care, establishing them as recognized experts in their field.

Chiropractors (DC)

Our credentialing service strengthens chiropractors' position in the medical community, giving them access to insurance networks and helping them connect with more patients.

Ambulatory Surgery Centers (ASC)

Credentialing through our service for ASCs boosts patient trust by showing commitment to strict quality standards, which are essential for ensuring safe surgical procedures.

Urgent Care Facilities

Our credentialing service ensures urgent care facilities are in-network with insurers, making fast and affordable medical services available to more patients.

Diagnostic Testing Facilities

Credentialing helps diagnostic facilities and clinical laboratories gain insurance approval, increasing patient referrals and enabling prompt diagnosis and treatment.

Behavioral Health Providers

Credentialing expands the reach of optometrists and audiologists, enabling them to provide essential eye and ear care services to a wider range of patients.

Behavioral Health Providers

Our credentialing service helps behavioral health providers join insurance networks, making essential mental health services accessible to those in need.