Credentialing New
CREDENTIALING AND ENROLLEMENT SERVICES
Credentialing and enrollment are the foundations of a healthcare provider’s ability to generate revenue, serve patients effectively, and maintain compliance. For solo practitioners, group practices, and large healthcare institutions alike, navigating this process is both essential and complex. At MedValue, we simplify this journey by delivering seamless, AI-powered credentialing and contracting support tailored to your organization’s needs.
Our end-to-end credentialing solutions include initial credentialing, re-credentialing, continuous monitoring, and payer enrollment services. Every application is reviewed by credentialing specialists who ensure adherence to NCQA standards, CMS regulations, and payer-specific guidelines.
Leveraging advanced artificial intelligence, MedValue automates time-consuming verification tasks through OCR (Optical Character Recognition) and document verification technologies. This significantly reduces manual errors, accelerates primary source verification (education, licenses, malpractice history), and shortens onboarding times—so you can start billing sooner.
Once credentialing is complete, our team supports you through every step of payer contracting—ensuring clarity in agreement terms, competitive reimbursement rates, and compliance with participation responsibilities. Clients also benefit from real-time dashboards, automated alerts for expiring credentials, and transparent access to the entire enrollment lifecycle.
We help providers enroll in national and regional plans, including:
MEDICARE
MEDICADE
AETNA
BLUE CROSS BLUE SHEILD
CIGNA
HUMANA
UNITEDHEALTHCARE
TRICARE
ANTHEM
UPMC HEALTH PLAN
KAISER PERMANENTE
CAREFIRST
MOLINA HEALTHCARE
OUR CREDENTIALING PROCESS
- Payer Research & Network Strategy – We assess national and regional plans aligned with your specialty and patient base.
- Application & Submission – Our experts compile necessary documents and submit applications according to each payer’s requirements.
- Credentialing Review – We track verification progress and coordinate follow-ups until committee approval.
- Contracting & Negotiation – We help review, revise, and finalize contracts for favorable participation terms.
- Ongoing Monitoring – Credentialing never stops. We manage re-credentialing, update records, and ensure regulatory compliance.
How long does credentialing usually take?
Credentialing timelines vary by payer, but most range from 60 to 120 days. We proactively manage each stage to accelerate approvals.
What’s the difference between credentialing and contracting?
Credentialing verifies your qualifications; contracting finalizes your participation and sets reimbursement terms with the insurer.
Which insurance networks should I enroll with?
We recommend payers based on your specialty, location, and target patient population. Our team conducts market research to optimize your mix.
What happens if a panel is closed?
We submit letters of interest and track opening windows. Alternative payers and out-of-network billing strategies are also explored.
Can you assist with government programs?
Absolutely. We manage complex enrollment for Medicare, Medicaid, and Tricare, including PECOS and state-specific forms.
How does MedValue use AI in credentialing?
AI drives document recognition, deadline tracking, and error prevention. This streamlines onboarding and reduces administrative overhead.