The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability
Act (HIPAA) Administrative Simplification Standard.
The NPI is a unique identification number for covered health care providers. Covered
health care providers and all health plans and health care clearinghouses must use the NPIs
in the administrative and financial transactions adopted under HIPAA.
The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means
that the numbers do not carry other information about healthcare providers, such as the
state in which they live or their medical specialty.
Most of the Commercial and Managed care plans requires every provider to have a CAQH
account, CAQH is an online database that record your personal as well as professional
information and this information is being accessed by health plans during Credentialing
process and/ or when you are due for Re-credentialing.
If your CAQH does not has the updated information, Health plans cannot complete the recredentialing process which can cause your termination from that health plan.
CAQH Require attestation once every 4 Months. We regularly review our clients CAQH
accounts to make sure it has current and updated information.
Credentialing is the process of provider credentials verification from Primary sources such
as Medical Degree from the Medical School, License from State, DEA Certificate from Drug
Enforcement Administration Department and Hospital Privileges from the Hospital.
It is a lengthy process and takes around 30 to 180 business day, varies plan to plan. All
Health care insurances and other accredited entities require every provider to go through
their credentialing process through which they confirm provider legitimacy.
Re-Credentialing is as important as Credentialing, Federal payers such as Medicare & Medicaid require every provider to validate their data once every 5 years.
This is required so that insurance as well as patients can have updated information such as
Provider Contract info, Certifications & Affiliations.
Once the Credentialing process is completed & Approved, Providers can go for a Contract (InNetwork status) or remain Non Contracted (out of network )
In Order to become an in network provider, Physicians are required to sign an agreement with
the insurance company.
The idea behind Contracting is to bind both parties on mutual terms in which providers are to
provide care to insurance members and Insurance companies are to pay providers for the services
they renders.
This Process takes about 15 to 45 days it includes Signing of a contract by both parties and
execution into insurance system.
Contracting is not important in every insurance or State but it does make a significant difference.
If you are not a contracted provider you may not get reimbursed for the services you provide, in
some cases insurances don’t even accept claims from Non-Contracted provider.
Having a Contract with insurance ensures Timely Re-imbursements, it also helps in increasing
your patients, every insurance list its Contracted provider’s details on their directories which help
insurance members find care near them and gives providers an advantage.
Non-Contracted Providers may get high Re-imbursements some time which involves your billing
office negotiation with insurance Claims department.
We strive to get our providers on every single insurance panel so that they can accept every
patient in their region .
Using our Demographic update services you don’t have worry about adding or removing a service location, Change in mailing address or change in Phone numbers. We can take care of all the paperwork on your behalf and we keep the provider directories up to date so you don’t lose your patients and important Notices.
Our Electronic data interchange services includes Electronic remittance advice setups
which can smooth your AR & Electronic funds transfer which will reduce extensive
paperwork.
You won’t have to worry about depositing manual checks every day, all the
payments will be directly deposited to you desired bank account. Federal payers are now
encouraging providers to have ERA/EFT setup to avoid delay and fraud chances.
Most of the commercial and managed care plans require each provider to have hospital
admitting privileges in one of their participating hospital, so that providers can admit their
patients if there is a need.
It could also be beneficial for you to get affiliated with different Surgery centers in your
region so that they can refer you patients who needs specialty care.
Hospital & Surgery center privileges involves lengthy application process and consistent
follow up, We make sure all our providers are on their desired panels and have mandatory
access to hospitals and surgery centers.
It is the most complicated process and takes a lot of time and effort. We complete all
compulsory documentation on your behalf.
Our Licensing Service includes but not limited to State License, DEA Certificate,
Professional & General liability insurance applications and Renewals.
We also help our clients in selecting most beneficial insurance companies for Malpractice.
There are 3 major types of medical licensing,
Full Unrestricted License:
Valid for 1 to 3 years, gives full privileges to physicians.Full Limited License:
Provides limited privileges to physician or non-physicianTemporary License:
Issued temporarily in order to combat emergencies or in circumstances where other type of license cannot be issued
Professional liability insurance comes in two basic forms one is called occurrence and the
2nd one is called claims-made
Claims-made insurance provides coverage only for incidents that occurred and were
reported while you are insured with that carrier..
Occurrence coverage provides lifetime coverage for incidents that occurred while the
policy was in effect, regardless of when the claim is filed. Thus, if you have an occurrencetype policy in effect for the calendar year 2007, and a patient files a claim in 2010 for an
incident that happened during 2007, the policy covers you for that claim, even if you no
longer have insurance with that carrier.
Claims-made policies are cheaper than occurrence policies for the first several years of
coverage because the potential for claims builds slowly as policy years accumulate.
Most policies offer limits of coverage ranging from $100,000 to $300,000 and $1 million to
$3 million.
A DEA number is assigned to Physicians practicing in United States which serves as an
identifier for the physicians allowed to prescribe controlled substances.
DEA registration is renewed every 3 years,
DEA numbers are assigned to all kinds of healthcare providers from veterinarians to
physicians as a way of regulating and tracking the prescribing of controlled substances.
Federal law requires that healthcare providers maintain a DEA number in order to write
prescriptions for these types of drug.
Priority Billing Service offers the best billing service in New York and New Jersey Our experienced staff handles your total billing activities such as guarantee creation, brisk accommodation, offers and installment postings.
