Insurance Credentialing

PROVIDER CREDENTIALING

The process involves the following steps:


1

Application Evaluation

Completing required documentation and identifying exceptions.

2

Primary Source Documentation

Verify practitioner/ facility information from physicians.

3

Outbound Call Center

Obtain missing documents and updating the payer's database.

4

Follow-up with payers

Follow-up on submitted credentialing requests

5

Data Entry

Capture data, label, and link images to specific providers/ facilities in the payer's database.

6

Maintenance of Provider Data

Update provider information as per policies and procedures, and CAHQ profile.

PROVIDER ENROLLMENT

Our Provider Enrollment services enable practices to get enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.

The process involves the following steps:


1

Verification of provider information

Contact payers to determine if they have the correct provider information on file before we submit claims

2

Updating practice’s Pay-to address

Validate and update the provider's pay-to address or the billing address



3

Enrolling for electronic transactions

Our team can enroll providers for four types of electronic transactions:

  1. Electronic Data Interchange (EDI)
  2. Electronic Remittance Advice (ERA)
  3. Electronic Fund Transfer (EFT) and
  4. CSI
4

Monitoring process

A group of highly skilled team members trained to perform research and analysis on the possible processor functionality gaps.

Ardur Technology is a Multi-Faceted organization offering diverse global business services like Title Insurance, Appraisal Services, Medical Insurance, Accounting

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  • +1 (702) 809 2713
  • +1 (702) 451 1125
  • info@ardurtechnology.com

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