We are not just an ordinary enrollment company that pushes through your paperwork, regardless!  With more than 18 years’ experience, we understand managed care payors and personally negotiate the highest reimbursement rate available for your specialty, specific to your practicing market.  We review and adjust payor contracts, removing adverse language, ensuring your ultimate benefit as a participating healthcare provider.

We complete, submit and manage all applications, by using the industry’s most innovative and efficient credentialing software; negotiate the highest market rate for your specialty, and provide complete management services for all contracts.

Credentialing Specialists, LLC, will take the pain out of your Managed Care Payor contracting and enrollment processes.  We simplify the process and offer enrollment “credentialing” packages, according to your practice’s needs and bottom line.

We take the worry and hassle from you when it comes to payor communication, contracting, negotiations and completion of enrollment processes.  It is a vital step for physicians and other healthcare providers who bill insurance companies, to have an experienced, assertive negotiator, who understands the importance of compensation, efficient and timely responses.

Our detail-oriented team, with more than 18 years’ combined experience, is a member of NAMSS, strictly adheres to NCQA (National Committee on Quality Assurance) guidelines and is HIPAA compliant. 

All our “credentialing” packages include:

• Contract negotiation
• Application completion
• Plan approval verification
• Contract delivery
• Follow-up to completion
• Change of service location or payment address

Comprehensive Packages include:

• Payor contract negotiation and language review
• Individual Practitioner, Ancillary and Group Agreements
• CMS and Medicaid enrollment and revalidation
• Unlimited facility/practitioner recredentialing
• CAQH – New provider initial set up and maintenance
• Provider data management with demographic updates for existing contracts

For sole practitioners to large group practices, providers joining other practices, the following services are available:

• Payor notification process to add single location with multiple affiliations
• Payor notification process for sole practitioner to a new group practice
• Medicare and Medicaid updates for sole practitioner and group practice