Credentialing refers to an elaborate process of verifying the gathered information of a provider and assessing their validity to enlist them with the insurance company. This process includes the verification of the provider’s qualification, certification, training, experience, and disclosures.

Contracting is the process of establishing a provider contract between a provider/group and the insurance company. The contract covers everything from reimbursement rates to provider networks, medical necessity, and provider credentialing.

Credentialing and Contracting

HOM’s provider credentialing service uses highly sophisticated tools, that are NCQA compliant, and help you gather, collate, analyze, and submit your data to the payor, ensuring a high success rate and improving the quality of healthcare and patient care. We help you generate Type-I & II NPI records for fresh graduates and newly formed groups. We assist in defining and explaining a provider’s reimbursement arrangement for delivering healthcare services to patients covered by a specific health plan, ensuring increased payouts.

We provide Medicaid and Medicare Credentialing and have a team of experienced professionals who specialize in using PECOS for seamless credentialing process. We are affluent with region-specific rules and regulations and cater to states such as Florida, Texas, California, Nevada, Ohio, South Carolina, North Carolina, Utah, New York, Illinois, DC, and PR.

We not only maintain but also create CAQH profiles of providers. CAQH profiles must be re-attested after every 120 days. Our state-of-the-art product Credaxis helps in seamless, 100% automatic renewal, making sure that the providers’ profile and insurance documents are always up to date.

We generate Type I and II NPI records for fresh graduates and newly formed groups respectively.

The NPI is a unique 10-digit, intelligence-free numeric identifier – implying that numbers do not carry other information about healthcare providers. It is compulsory for all providers to obtain NPIs. Clearinghouses must use the NPI in the administrative and financial transaction.

NPIs work as standard unique health identifiers for health care providers, health care plans, and employers.

Medical License require renewal every 2 years. We begin the renewal process 3 months before the expiry date to avoid any irregularities, aiding a 100% renewal rate.

We ensure your documents are up to date and accurate to deliver a seamless and timely renewal of your medical and DEA licenses.

We provide all types of hospital privileges and re-appointments after every 2 years. Getting privileges with hospitals can be a tedious process as each hospital has a different checklist.

Our work relationships with various hospitals and knowledge of their required checklists help us in obtaining the hospital privileges in a swift and seamless manner.

Our on-shore team provides insurance companies with delegated credentialing services. We have tie-ups with various big group practices and help insurance companies to delegate their credentialing processes.

Our Tech

Our technology enables seamless operations and improves procedural efficiency reducing processing time by up to 50% and resulting in higher satisfaction.

A robust system to collect, track and maintain data through the latest technology and infrastructure.

All verification and legitimization processes comply with NCQA, URAC, and JCAHO standards.

Highest productivity and quality standards with competitive pricing.

Secure storage of all documents on the client’s server, less chance of a breach.

More acquainted with payor requirements for the credentialing.

Our Edge

01

Collecting data smoothly and auto-populating it in CAQH.

02

Integrates easily with your existing system, helping you focus on patients at a fraction of the cost.

03

Highest first-pass rate of application among peers.

04

Optimize payments against CPT codes.

05

Automatic, timely notification for renewal.

Up to

50%

reduction in
processing time

 

400+

tasks completed

 

99.8%

accuracy

 

50+

years consolidated experience

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