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Total Medx Credentialing Services

At Total Medx, we offer comprehensive credentialing services designed to help healthcare providers navigate the complexities of credentialing, ensuring that your practice remains compliant, efficient, and positioned for growth. Our team of credentialing experts works diligently to manage the credentialing process with payers, hospitals, and medical boards, allowing you to focus on delivering quality care.

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First-Class Reimbursement

Unlock the benefits of premium reimbursement rates with Total Medx. Our expert team works to position your practice for top-tier reimbursements, ensuring you receive higher payment rates for the same services.

Maximum Privileges

Unlock maximum privileges with Total Medx credentialing services. We ensure that your practice gains exclusive access to the highest-tier insurance networks, giving you preferential reimbursement rates and expanded patient access.

Billing-Ready Solutions

Ensure your practice is always billing-ready with Total Medx. Our streamlined processes and expert guidance guarantee that your claims are accurate, compliant, and fully prepared for submission.

Swift Reimbursement

Experience the power of swift reimbursement with Total Medx. We prioritize fast, accurate claims processing to ensure your practice enjoys a consistent and healthy cash flow.

Payer Support

Our advocacy ensures insurance companies stand by you, supporting your needs. We negotiate on your behalf and resolve any issues that may arise, ensuring you get paid fairly and promptly.

Minimize Denials

With our expertise, denials become a thing of the past, boosting your efficiency. We verify eligibility, obtain authorizations, and submit accurate claims, reducing errors and rejections.

Total Medx Provider Credentialing Services

Credentialing is a critical process in healthcare that establishes a provider’s qualifications and ensures they meet the rigorous standards required to deliver quality care. It involves verifying a provider’s professional background, including their education, training, work history, licenses, certifications, malpractice claims, and any disciplinary actions. The credentialing process also checks that a provider is compliant with the relevant regulatory requirements set by both state and federal authorities.

Once credentialed, healthcare providers gain access to participate in various insurance networks and are eligible to bill insurance companies for services rendered. This allows providers to operate efficiently and be reimbursed for their work, ensuring a steady cash flow for their practice or healthcare facility. Furthermore, being credentialed with reputable payers such as Medicare, Medicaid, and private insurance companies like Aetna, Cigna, and UnitedHealthcare, boosts a provider’s credibility and opens up opportunities to serve a wider patient base.

 

Our Medical Credentialing Process

A Comprehensive, Streamlined Approach to Provider Enrollment

At Total Medx, we take a meticulous and strategic approach to the medical credentialing process, ensuring your practice is successfully enrolled in premium payer networks and fully compliant with industry standards. Our credentialing specialists have a proven track record of getting providers approved quickly, with a 98% success rate in securing premium payer network access, and maximizing privileges in specific specialties. Here’s a walkthrough of our detailed process:

1. Provider Assessment And Data Collection

Our credentialing process starts with a thorough assessment of your professional credentials. We conduct comprehensive interviews with each provider, gathering critical information such as medical licenses, certifications, educational history, professional background, and current practice demographics. This step ensures that all required data is accurately collected for proper submission to payer networks.

2. Identifying The Right Insurance Networks

We work closely with providers to strategically choose the most suitable insurance networks based on their specialty, location, and practice goals. This step involves selecting payer networks that will offer the best reimbursement rates and access to a broad patient base, such as CMS/Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, and others, ensuring long-term success for your practice.

3. CAQH Profile Management

Total Medx handles the entire CAQH (Council for Affordable Quality Healthcare) enrollment and management process. We ensure your CAQH ProView account is set up correctly, regularly updated, and maintained to reflect current credentials, certifications, and licensure. We also take care of CAQH application submissions, ensuring a smooth and efficient verification process. Our team ensures your profile is accurate and up to date for seamless payer integrations.

4. Primary Source Verification

We conduct primary source verification to validate your credentials with authoritative organizations such as state medical boards, education institutions, and professional certifications boards. This step ensures compliance with all regulatory requirements and helps avoid costly errors that could delay credentialing or cause claim denials.

5. Payer Network Enrollment And Integration

Our credentialing experts manage the payer enrollment process, ensuring all paperwork is completed and submitted to relevant insurance companies. We streamline the insurance panel integration, helping your practice quickly gain access to premium payer networks. By facilitating fast approvals, we get your practice credentialed and ready to see patients in a timely manner.

6. Continuous Credentialing Support

Credentialing doesn’t stop once your practice is enrolled. Total Medx offers ongoing credentialing support, including re-credentialing management and ensuring your credentials remain compliant and up-to-date with all applicable regulations. We track re-credentialing deadlines and handle the submission of necessary documentation, ensuring there are no interruptions in your ability to bill and receive reimbursements.

7. Insurance Panel Customization

We customize your insurance panel selections to ensure you are enrolled in the networks that best match your practice’s patient demographics, location, and specialty. By carefully selecting the right networks, we ensure your practice receives maximum reimbursement rates and expanded access to patients.

8. Fast and Accurate Processing

At Total Medx, we pride ourselves on fast, efficient credentialing that minimizes downtime for your practice. We process all documents and applications promptly, ensuring that your practice can start billing and receiving payments faster, reducing the impact on your cash flow.

Contract Negotiation

Our credentialing team provides support to the doctors with negotiating contracts with insurance payers, which are the agreements that define the terms and conditions of the provider-payer relationship. By negotiating contracts, medical practitioners can secure favorable payment rates, dispute resolution processes, quality measures, and network inclusion.

Revalidation And Re-Credentialing

Our medical insurance credentialing service manages every physician’s revalidating and re-credentialing enrollment process and credentialing status with Medicare, Medicaid, and commercial insurers. With Total Medx managing these processes on autopilot, providers can maintain their eligibility to participate in these programs and avoid any interruptions or penalties.

Reimbursement Issues Audit

Our credentialing and privileging specialists audit reimbursement issues, such as underpayments, denials, delays, or errors from insurance payers. Providers also get accounts receivable (AR) follow up services to help collect outstanding payments from payers. By auditing reimbursement issues and following up on AR, providers can improve their cash flow, reduce their bad debt, and optimize their revenue cycle.