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Credentialing

MDofficeManager provides credentialing services at an hourly rate or by a monthly fixed cost per provider.

The first step in this process is to determine which insurance/HMOs/PPOs are the most widely used insurance companies in your area. We then work with you to apply for in-network status. MDofficeManager can perform all of the credentialing processes or share the responsibilities with you.

The credentialing tasks we complete include the following:

  • Determine if you are eligible to apply for in-network status with various insurance/HMOs/PPOs.
  • Obtain the necessary paperwork to complete the application.
  • Complete on-line applications, including CAQH and other credentialing organizations
  • Apply to obtain an NPI.
  • Follow up to track the status of applications and supply missing information as needed
  • Complete re-credentialing paperwork as requested by insurances/HMOs/PPOs

Important things to keep in mind when using our credentialing service:

  • We will ask you to provide several pieces of information required to apply for your credentialing and CAQH application.
  • There are likely to be forms that need information that only you can fill out, such as clinical specialties, etc. We will forward these forms to you for completion.
  • Many forms will require your signature. We will send you these forms to be signed.
  • It is often the case that insurance/HMO/PPO panels are closed or do not accept a particular applicant. We cannot guarantee that you will be accepted into any particular panel and you may end up paying MDofficeManager to apply to panels for you and still not be accepted.
  • We will need several documents and pieces of information from you to complete this process. We will let you know what is needed and the successful completion of this process relies on you supplying the needed documents and information to us in a timely fashion.
  • The credentialing process can take a long time. Please expect that for many insurances, the time from when we first inquire to when you are actually accepted into a panel and can begin seeing patients can be as long as 6 months.