Service List

Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.  Therefore, it is important for healthcare providers to get enrolled and credentialed with maximum payers so that patients can use their insurance plans in your practice - failing to do so will result in the patient looking for competing providers who are enrolled with the health insurance companies they are subscribed to.

However, the process of getting a provider credentialed with a payer involves a lot of manual work in terms of completing the application forms, providing clarifications to questions from payers, and following up with them to close the credentialing request. Trust ZX Healthcare Solutions to get you credentialed fasters as we understand the forms required by each payer, and their policies and procedures.

PROVIDER CREDENTIALING

The process involves the following steps:

• Application Evaluation. Completing required documentation and identifying exceptions.
• Primary Source Documentation. Verify practitioner/ facility information from physicians.
• Outbound Call Center. Obtain missing documents and updating the payer's database.
• Follow-up with payers. Follow-up on submitted credentialing requests.
• Data Entry. Capture data, label, and link images to specific providers/ facilities in the payer's database.
• Maintenance of Provider Data. Update provider information as per policies and procedures, and CAHQ profile.

PROVIDER ENROLLMENT

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:

• Verification of provider information. Contact payers to determine if they have the correct provider information on file before we submit claims
• Updating practice’s Pay-to address. Validate and update the provider's pay-to address or the billing address
• Enrolling for electronic transactions. Our team can enroll providers for four types of electronic transactions:
  • Electronic Data Interchange (EDI)
  • Electronic Remittance Advice (ERA)
  • Electronic Fund Transfer (EFT) and
  • CSI
• Monitoring process. A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

Our experienced team specializes in managing all aspects of provider enrollment and credentialing, including completing applications, verifying credentials, and obtaining necessary approvals. We ensure timely and accurate enrollment of providers with payers, hospitals, and other healthcare organizations.

In addition to enrollment services, we offer ongoing credentialing maintenance to ensure providers remain compliant with payer and accreditation requirements. Our solutions help healthcare system providers avoid delays in reimbursement and maintain high standards of care delivery.

By partnering with us, you can improve provider satisfaction, reduce administrative burdens, and enhance patient access to care. Our services are customizable to meet the unique needs of your organization and can be seamlessly integrated into your existing workflows.