Contracting & Credentialing

As part of our complete practice management solution, Integrated Healthcare Resources provides contracting and credentialing for our medical billing and coding clients. These healthcare billing services are ancillary to the practice management services and medical billing process, but that makes them no less necessary.

Integrated Healthcare Resources helps you access the benefits provided by contracting and physician credentialing services and utilizes those benefits to attain better rates of reimbursement for our healthcare providers.

Benefits of Credentialing and Contracting

Being in a provider network will also serve as a form of advertising, as all healthcare providers in the network will be listed on the insurance company’s website as an available provider, as well as in any other documentation provided to the insured for finding healthcare providers. Also, insured patients will be financially incentivized to use an in-network provider over others, providing a guaranteed pool of customers for your practice or facility.

Are you ready for the new requirements?

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Our Credentialing Services

As part of our physician credentialing services, Integrated Healthcare Resources implements a process that involves verifying the training, education, and skills of your practice’s physicians and other healthcare providers. During the medical credentialing process, many different submissions, such as physicians’ licenses, medical school records, and diplomas from universities and medical schools, along with proof of internships, residency, and fellowships, must be verified.

In order to verify a medical provider, the medical credentialing professional will reach out to the original source, which means directly contacting the school, licensing body, or other entity that provided the original training or license. In this way, the accuracy of all claims made as to medical competency and right to practice can be directly verified.

The medical credentialing process can often take a long time, depending on what exactly must be verified. However, the medical credentialing service is absolutely necessary for any healthcare provider who wishes to be part of a provider network.

Contracting with Provider Networks

Contracting is the process of forming an arrangement or contract between a healthcare provider and an insurance company to form provider networks. These networks have become ubiquitous, as they provide many advantages useful for the delivery of health care services to patients and clients of insurance companies. In order to contract with an insurance company in this way, all healthcare providers must be credentialed.

There are many benefits to contracting. Claim payments are made more frequently to providers in the network than those outside it, often rendered on a weekly basis. Representatives of the insurance company responsible for maintaining positive relations with in-network providers will be available to assist with billing or coding difficulties, in order to keep the provider network functioning smoothly.

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