Clarus RCM provides a team of credentialing experts to ensure your physicians are credentialed by payers, enrolled for EDI transactions, and subsequently, re-credentialed.

Provider Credentialing Services

The documentation requirements for various health plans vary. We bring the knowledge of credentialing physicians for various health plans and apply the expertise to get your physicians credentialed faster. Timely credentialing reduces out-of-network denials and improves your cash flow. Gain from our expertise and maintain credentials with most health plans that you support.

We follow the following approach to credentialing.

  • Assess documentation needs. We understand the health plan’s documentation requirements and start collating the physician credential information to support the documentation. We work with the physician to not only obtain their credentials but also reduce documentation burden by cataloguing the information. We also identify and report any exceptions to the documentation requirements. We also make calls to physicians to obtain these documents.

  • Primary source verification. We perform primary source verification such as criminal background checks, education, hospital admitting privileges, DEA certifications, National Provider Data banks, references, work history, and state licenses, using primary source verification engines provided by you.

  • Compile the application and submit. We compile the application in the formats desired by the payers by populating the information received

  • Periodic Follow-up with Payers. We follow-up with the payers on the submitted applications to expedite the credentialing process.

  • Maintenance of Provider Catalog for re-credentialing and updates. We maintain and update the provider data in a catalogue for use with other payers.

Provider Enrollment Services

Provider Enrollment for EDI transactions reduces a lot of manual revenue cycle processes. We review the available provider information to ensure accuracy of enrollment applications and register the provider for different types of EDI transaction. Post initial enrollment, we maintain the provider information on CAQH and set up alerts to notify when you are required to re-enroll.

Benefits of our Provider Credentialing and Enrollment Services

  • Arrest revenue leakage by avoiding out of network denials

  • Improve speed to care by ensuring that the specialist physicians you call upon are credentialed ahead of the patient visits

  • Get more patient referrals by becoming part of the health plan’s network and improve your revenue.

  • A structured cataloging process that reduces ongoing administrative burden and only incremental documentation needs are passed to the physician

  • Daily account support calls to address any issues

  • Reduce costs by as much as 50% through offshore delivery

Connect with Us

To learn more about our Provider Credentialing and Enrollment Services, please fill the form and we will be in touch.