Grow your network, Grow your revenue
Years of Provider, Hospital
Credentialing and Enrollment
Whether you’re a private practice or larger healthcare facility, insurance credentialing is the first and most important step in implementing your new revenue cycle. Yet, even when you know which insurance companies you want to participate with, getting credentialled is a time-consuming and often frustrating process. That’s why many healthcare organizations outsource this crucial step.
Bikham Healthcare wants to be your Practice Management Concierge service. We handle insurance credentialing for physicians, hospitals and a wide variety of other healthcare institutions. From start to finish, we will walk you through each step of getting approved with an insurance payer. Learn why countless healthcare professionals and organizations entrust us for medical insurance credentialing services.
Years of Provider, Hospital
Credentialing and Enrollment
In today’s healthcare marketplace, the ability to accept potential patients’ insurance plans is essential for your practice's success. Health insurance credentialing, also called provider insurance credentialing, is a process that medical insurance companies use so that you can apply for inclusion in their provider panels. If you wish to bill an insurance company as an in-network provider, you must undergo the credentialing process.
First, the insurance company you’re applying to will verify that you meet their internal requirements so that you can serve as an in-network provider on their panel. This could include your level of education, training and professional experience.
Once your practice or organization is credentialed with an insurance company, you can bill the payer directly. Also, many insurance companies offer providers other incentives, such as:
With Bikham Healthcare, we help you get your applications completed twice as fast for Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, TRICARE and almost any other provider. Below are just a few functions we perform on your behalf throughout the credentialing process.
We make sure your Practice or Group has the most varied, popular and effective in-network payer mix.
Our credentialing team has extensive experience in enrolling physicians with Medicare, all Medicaid’s Managed Care plans along with all commercial payers.
Our team reaches out to each shortlisted payer that you want to enroll with and gets accurate timelines and open panel availability.
We send you a complete checklist of all the information and documents that are required to file the applications.
As soon as we have the details from you, our Enrollment team goes ahead and files the appropriate contract applications and makes sure it’s a flawless submission in the first go, owed to our extensive experience. As a result of our first-time correct application submissions, we proudly boast of the shortest turnaround time in getting the contract.
Our team follows up on the submitted application every two weeks, to ensure that the submitted application has been received and is in the payer’s system and that no additional information is being requested and everything is smooth. We follow-up regularly until the contract comes through and is delivered to your physical location.
Payers like UHC, Aetna and BCBS sometimes have closed panels for Labs for a particular area. We make sure to send an extensive appeal outlining the key points of your whybk, including niche whybks and details on how you bring exceptional patient care in your area. All these details are included in your business plan and submitted to senior provider representatives at that payer. While it can be difficult to overturn the closed panel decisions, we have a 30% success rate.
This is for all providers who choose to stay out of network with certain payers. Or if due to any closed panels, are forced to stay out of network. Our team helps with out of network enrollments, NPI registrations on the payer’s website etc. so that your medical practice is in the payer's system to start receiving out of network payments.
We help with all basic and complex demographic changes such as updating a new TAX ID with all payers in your payer mix, updating a new address, bank account, etc. We also help set up all ERA and EFT enrollments.
For larger healthcare facilities with multiple providers, accurate provider database management is pivotal. We manage and maintain all your providers’ and physicians’ credentialing data on our credentialing portal. It’s a very comprehensive, transparent and HIPAA compliant tool that we specifically designed to make sure we upkeep your database with the utmost efficiency and accuracy.
Keeping up to date PECOS and CAQH profiles is of utmost necessity in today’s healthcare environment.
The biggest payers are all turning the CAQH route to credential and enroll medical providers. We maintain and upkeep your CAQH and PECOS profiles, making sure all your information is accurately profiled and compliant.
Check out the most popular payers in your State. Compare with your patient inflow and see which ones you need to be contracted with.
We can get it for you in the fastest TAT and the best contract rate.
When considering which insurance companies you should be credentialed with, you must look at the major national plans, such as:
However, you also need to know which local insurance companies may be valuable. To determine this, consider asking a peer or another practice in your area which local health insurance companies best meet the needs of your patient base.
When you work with Bikham Healthcare, we do extensive network research to ensure your practice or group includes the most varied, popular and effective insurance providers. We consider a variety of factors, including the top payers and your budget. We then follow up with you on this list until you give us the green light to go ahead.
Those establishing a private practice are often confused about insurance credentialing and procedures for billing third-party networks for their services.
The first step in setting up your revenue cycle is applying for credentialing and obtaining participating provider contracts with your chosen insurance companies. While this can be complicated, Bikham Healthcare takes on this cumbersome process on your behalf. We provide you with guidance and industry know-how so that you can set up the revenue cycle for your new practice with ease.
Provider enrollment and insurance credentialing for government health programs such as Medicare, Medicaid and Tricare are a bit different. These programs have standardized forms that must be accurately filled out. They must then go to the appropriate intermediary who handles the administrative duties for the program in your jurisdiction.
Bikham Healthcare understands these strict enrollment standards. We will take on this very detailed enrollment process so that your application has less risk of denial.
If you want to know how to get credentialed with insurance companies, please be aware that this process may take several months, and many insurance companies may not be accepting new providers on their panels. That’s why it pays to outsource this involved process. We provide professionals and organizations with extensive research and expertise to ensure we follow each payer’s guidelines, including:
Many insurance companies split their credentialing process into two parts — credentialing and contracting.
We will help you submit a participating request to your chosen health plans using their specified credentialing application process. Once the health insurance company receives your credentialing application, employees perform a thorough verification process. Your file will then go to the company's credentialing committee for approval. This process can take upwards of 90 days.
While this phase may feel drawn out, your dedicated Bikham Healthcare account manager will provide you with weekly or even daily real-time application updates.
The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.
We help you through credentialing and also assist you with contracting negotiations before you sign your agreement, including:
Once you sign your agreement, you will get an effective date and provider number. Then, you can start billing the plan and receiving your in-network reimbursements.
Since 2005, Bikham Healthcare has worked with healthcare practices and organizations across the U.S., providing impeccable credentialing and enrollment services. If you need assistance completing the credentialing process with insurance companies in a timely manner, we ensure your credentialing and contracting goes as seamlessly as possible.
Countless organizations in every facet of the healthcare industry turn to Bikham Healthcare because we customize our medical billing services to fit our clients' needs. From consulting to taking action on your behalf, learn more about our services when you contact us online. Or, give us a call.
Worried about a growing backlog of claims and looming deadlines?
Laboratory credentialing and payer Enrollment is a whole different animal. With Bikham's decade long experience in Laboratory RCM, we pioneer the Lab payer Enrollment space. We work very closely with your management groups and ordering facilities to make sure we map out the effective areas your Lab is getting maximum business from or the areas where you might get prospective business from. Multi state payer Enrollment is essential for any laboratory's growth and we make sure your Lab has the most extensive in network contract directory so you don’t have to turn away business.
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See how in just 14 weeks Bikham’s Enrollment team assisted a Urology group in getting credentialed and enabled them to submit over 3.5 million in backlogged billing successfully. Besides focusing on the problem areas, Bikham's Enrollment team passed some testing challenges. With their scalable approach, they achieved their goals and continue to work with the client since then.
Read the Case StudyWe always love to share advice, tips and knowledge about the Insurance Credentialing process, helping to make it easier for you. This part of our website helps you explore various topics.
Find the article of your interest from the list:
Transparency is key. Our comprehensive online tool is an effective platform that provides complete transparency of the work flow, the application status, extensive reports, secure and HIPAA compliant document storage and gives other important information about your payer network. By offering accurate, real-time information to everyone involved in the credentialing continuum, we have helped many leading medical providers to achieve new levels of transparency and ease of achieving fast and accurate payer Enrollment work flow.
Provider engagement is not only met with the right information at the right time, but expectations are also exceeded with answers to questions and estimates regarding credentialing costs.
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