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Insurance Credentialing & Enrollment

Credentialing is a process insurance companies use to ensure that you are qualified to serve on their panel. They often list credentialed providers on their websites, and customers often use the insurance company website in order to find providers who accept their insurance in the local area.

Get credentialed!

If you aren’t already credentialed, you’ll need to start here. Being credentialed with an insurance company allows you to become an in-network provider.

Why is that important?

Depending on your patient’s specific insurance policy, if you don’t go through the credentialing process, you may not receive payment for your out-of-network claims.

Most government insurance companies don’t pay out-of-network providers. Furthermore, if you’re not credentialed with Medicare, you cannot treat-or collect payment from-Medicare patients for any Medicare-covered services.

Additionally, being a credentialed provider gives you more exposure. Patients often check their insurance company’s website for a list of local providers; if you aren’t a credentialed provider with that company, you won’t be in their list.

Plus, if any of your therapists worked previously at another clinic, you’ll need to determine if they were credentialed as a group or an individual provider. If they don’t have their own contract, they likely aren’t covered and you will need to have them credentialed if you plan on billing services under them.

3 Step Process to becoming credentialed

  • Register for a National Provider Identifier (NPI) number.

  • Request a Council for Affordable Quality Healthcare (CAQH) number and complete CAQH File.

  • Complete a credentialing application for each health plan from which you will seek reimbursement.

How can Amvik Solutions help?

Amvik collects all the necessary information from our clients through a "Provider Enrollment Questionnaire". Our expert team handpicks all of the relevant data from the questionnaire and required documents (resumes, licenses, certifications and degrees) and will submit the credentialing application on your behalf.

Amvik Solutions’ team also maintains the credentialing data of our clients in the CAQH database and updates this information quarterly. Any participating health plan authorized during the application process will be notified of new or updated information in the CAQH database. Each participating health plan will continue their own internal processes to confirm your information and make independent credentialing decisions.