Credentialing Process at Novita

There are various steps involved in the complete credentialing and contracting process. Every step is very important and should be managed very carefully as any errors can lead to a longer credentialing process and can result in heavy financial loss for the provider/practice. Our expert with 15 years of insurance relationship management experience will help you sail through the difficult steps with ease.

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Physician Credentialing

Get Ready for The Future, Today!

Credentialing and contracting are the basis of starting a clinic or healthcare facility. It sets the foundation for how your practice is going to do in the future years.

The healthcare organization and provider cannot be paid by that carrier for services rendered unless they are properly credentialed. Each insurance carrier has a unique credentialing process and every physician in your practice will need to go through the medical credentialing process for that carrier before claims can be processed. Any clerical error or missing information may cause the credentialing to be declined. That scenario can lead to a longer wait time for payment of services and, in some cases, may mean that payments will not be honored by the insurance carrier. Physicians cannot be granted privileges in most healthcare organizations without first completing the medical credentialing process.

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Benefits of Novita Credentialing Service

With our diligent credentialing and Enrollment services, you get the following benefits:

o Get credentialed faster with all significant payers
o Reduce claim denials and improve cash flow
o Get more patient referrals from the network
o Avoid piles of paperwork with our document management system
o Get support for filling up cumbersome application forms
o Reduce costs of the credentialing process with our global delivery teams
o Get timely reports on the status of your applications

We have helped many providers and practices with the initial credentialing, re‐credentialing, and getting the best out of
their practices.

What Novita Offers

We start with the first step and collect all the required information and documents to file applications. The information and documents are provided by the provider or practice. The documentation requirements vary from payer by payer.

Novita

New Credentialing

  •  Medicare Individual Credentialing
  • Medicare Group Credentialing
  • Individual providers benefit reassignment to group
  • Medicaid Individual Credentialing
  • Medicaid Group Credentialing
  • Individual and Group Credentialing with Commercials

Contracts Creation and Maintenance

  • New Group/Individual Practitioner contracts

  • Adding / Deleting providers in the existing contract

  • Adding/Deleting location in the current contract

  • Adding / Deleting plan types ( Line of Business ) in the current contract

CAQH Attestation

  • CAQH application filing

  • CAQH quarterly attestations

  • Expirations and Renewals

  • The tracking expiry date for State DEA License, Board certificate, and Malpractice Insurance

Novita

Provider Data Maintenance – Update Management on Payer Systems

  • Provider demographic update in payers file. 
  • Provider directory maintenance on payer websites. 
  • EFT/ERA enrollments

Tracking and Analytics

  • Maintaining a repository of provider’s credentialing documents
  • Maintaining Contracting agreements
  • Tracking credentialing dates, expiration, and alerting dates to initiate credentialing processes
  • Working with the denials team to understand if there are any claim denials due to credentialing issues

Numbers & Achievements

We did awesome work with business ethics.

15

Years of Experience

99

% First Pass Rate

15

% Revenue Increase

100

% Coding Compliance

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Physician Credentialing FAQs

What is the purpose of physician credentialing?

It helps to ensure that healthcare facilities only contract with qualified and competent physicians to provide patient care.

What kind of information is required for physician credentialing?

Physician information such as education, training, work history, license, and insurance details are typically required for credentialing.

What are the benefits of using a physician credentialing service?

They streamline the credentialing process, reduce administrative burdens, ensure compliance with regulations, and provide a secure and centralized database of physician information.

What kind of healthcare facilities use physician credentialing services?

Hospitals, clinics, private practices, and other healthcare facilities use physician credentialing services to manage the credentialing process for their contracted physicians.

Louise Maxwell

Louise Maxwell

General Physician, Gadsden Physician Clinics

I have been using Novita for my coding for the last couple of years, and I no longer fear payers’ audits. They code my charts, do an internal audit of the charts once every three months which makes me always ready to respond to any queries insurances come up with on my coding. They do their job best while I do mine which is to focus on patients' care.
Gabriella Spring

Gabriella Spring

Practice Manager, Madison Family Practice

It is always hard to keep the scheduling staff trained as the employee turnover is high. I suffered for several years mentally and financially as I had to keep hiring, training, and then seeing them go for another opportunity. It kept on happening until Novita took over appointment scheduling, confirmation, and benefits verification. They have been doing an exceptional job.
Josh Phillip

Josh Phillip

Medical Assistant, Hemken Family Medicine

Just a year ago, I had to spend a lot of time babysitting my biller and still many of the claims would remain unpaid after months of billing. Novita Management Service has not only cut my cost to half, but I have seen about a 12% increase in monthly revenue. They are the best.