Credentialing and Contracting
Making Credentialing Easy and Helping Healthcare Professionals Succeed
ZMC specializes in making medical credentialing simple and stress-free for healthcare professionals. Our services are designed to take the administrative burden off your shoulders, allowing you to focus on providing exceptional care to your patients. From securing privileges and integrating with insurance networks to accelerating reimbursements, we handle the details so you don’t have to.
Take advantage of higher reimbursement rates, so you get paid more for the same services. This helps increase your profits and satisfaction.
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.
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.
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.
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.
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.
ZMC provider enrollment services open the door to in-network contracts, even with the most exclusive payor panels.
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.
Our credentialing process begins with a detailed survey conducted by our experts. This step includes interviews with providers to gather essential information, such as license numbers, educational history, professional background, and demographic details.
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.
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.
While the standard process takes 60-120 days, we accelerate the timeline by proactively engaging with payers. Our team follows up weekly to ensure quick processing and approval of credentialing applications
Once credentialing is complete, we assist with the contract phase. This involves negotiating in-network contracts, securing fee schedules, and tackling closed panel challenges through appeals. We ensure smooth integration into networks and work to maximize reimbursement rates.
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.
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.
Helping Healthcare Providers With All Their Credentialing Needs
ZMC provides comprehensive provider credentialing services to healthcare professionals and organizations. 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
We help providers with credentialing with top commercial insurers like Aetna, Humana, and others, granting access to private health plans and networks. Credentialing with these insurers allows providers to expand their patient base and negotiate better reimbursement rates.
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.
CAQH Registration and Maintenance
We help providers stand out from their peers by managing their profiles on the Council for Affordable Quality Healthcare (CAQH) ProView. This online database collects and verifies provider information for credentialing purposes. By using CAQH ProView, providers can streamline their credentialing process across multiple health plans, making it more efficient and effective.
MCR DMEPOS Enrollment
Providers using our credentialing service can enroll in the Medicare DMEPOS program, which covers items like wheelchairs, oxygen equipment, braces, and diabetic supplies. 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
We assist physicians in obtaining and renewing their hospital privileges, which are the rights granted by a hospital to a provider to practice within its facilities. With hospital privileges, providers can admit and treat patients, access hospital resources, and collaborate with other healthcare professionals, enhancing their ability to provide comprehensive care.
Our credentialing team supports doctors in negotiating contracts with insurance payers, which outline the terms and conditions of the provider-payer relationship. 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.
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.
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.
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:
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.
Credentialing via our service aids PAs/NPs in expanding their practice reach, ensuring they’re authorized to deliver essential medical services independently.
Credentialing with us simplifies hospital operations, making insurance claims processing more efficient and promoting better collaboration among medical staff.
Our credentialing service helps therapists join insurance panels, allowing them to provide essential rehabilitation services while ensuring financial stability.
Credentialing through us helps podiatrists provide specialized foot care, establishing them as recognized experts in their field.
Our credentialing service strengthens chiropractors' position in the medical community, giving them access to insurance networks and helping them connect with more patients.
Credentialing through our service for ASCs boosts patient trust by showing commitment to strict quality standards, which are essential for ensuring safe surgical procedures.
Our credentialing service ensures urgent care facilities are in-network with insurers, making fast and affordable medical services available to more patients.
Credentialing helps diagnostic facilities and clinical laboratories gain insurance approval, increasing patient referrals and enabling prompt diagnosis and treatment.
Credentialing expands the reach of optometrists and audiologists, enabling them to provide essential eye and ear care services to a wider range of patients.
Our credentialing service helps behavioral health providers join insurance networks, making essential mental health services accessible to those in need.
Zee Medical and Commerce Group offers streamlined medical billing and custom eCommerce solutions, helping healthcare and retail businesses boost efficiency, sales, and customer satisfaction.
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