Capital Healthcare provides assistance to Dental and Medical practitioners to streamline and simplify the process of credentialing and office operations. We diligently work to get our doctors enrolled in selected insurance companies. Our firm understands the rules and regulations of different insurance organizations and their unique credentialing requirements. Moreover, our staff will simplify the process for you by eliminating the aggravation and hassle of completing multiple applications which can be tedious and time consuming, leaving you able to devote more time to your practice.

We realize that you have all kinds of tasks on your plate with your office build out, staffing and equipment choices and all the other details of launching your new practice. With our credentialing services, our process is transparent and our goal is to ensure that you start off your practice on the right foot. Provider enrollment is an inevitable process that comes with running your office. Becoming a provider with top paying commercial and government insurance carriers is essential to maintaining steady patient referrals and cash flow and are the backbone of any successful practice. For a normal practice, you might see 15% to 25% of your patients through Medicaid depending on the population you serve and where you are located. After that, it is normally 7 or more commercial payers that will drive 70% or more of your patients to your practice.                                                                                                                                         

What to expect with our Provider Enrollment and Credentialing services?

Simply put, we handle the entire enrollment and credentialing process from start to finish.

· We complete all applications and necessary paperwork on your behalf for enrollment/credentialing with the chosen commercial networks and government entities.

· We make all phone calls, follow-ups and submit all applications, emails and faxes for you.

· You are assigned a dedicated practice coordinator to represent you with all commercial and government payers.   

· Status reports are provided throughout the project, so you know where you are in the process with each payer. Our job is not done until the process is 100% completed.

Applications are completed in 25 to 50% of the time it takes when handled in-house, saving you on average at least 2 months of time and over 100 or more hours of work.  Enrollment and contracts are setup right the first time to avoid these most common mistakes:

1. Starting Too Late

In ideal situations, you would want to begin the process at least 90 days prior to opening (with the exception of a provider already joining an existing practice). For new start-up it can take at least 4 – 6 months to complete the entire process. Doing it on your own could take 8 – 12 months. Many practices simply cannot survive within that time frame.

2. Forgetting to include complete information

An insurance company needs a thorough picture of your current and past medical practice to determine if you would be a good fit for joining their provider network. The data required includes practice address, phone/fax number, contact information, services provided, copies of your license, employment history, average patient profile and any records of past legal troubles regarding your medical practice. Omitting any of the required data will lead to delayed processing by insurance carriers and even denials into the network as a participating provider.

3. Lack of Follow-Up

As mentioned above, the average provider enrollment/credentialing process can take months. Constant communication with the insurer will keep you up to date on your application’s status. Many insurers are understaffed and the process takes much longer than in the past and being proactive will help to shorten this waiting period in most cases. 

 

Our services include:

- Initial provider enrollment with major commercial carriers (e.g. Aetna, BCBS, Cigna,  Human, UnitedHealthcare and many more)

- Medicaid provider enrollment and credentialing

- Relocation

- Practice NPI Registration (Type II)

- CAQH Registration