New Credentials – MedValue

Whether you’re a private practice or larger healthcare facility, insurance credentialing is the first and most important step in implementing your new revenue cycle. Yet, even when you know which insurance companies you want to participate with, getting credentialled is a time-consuming and often frustrating process. That’s why many healthcare organizations outsource this crucial step.

Medvalue Healthcare wants to be your Practice Management Concierge service. We handle insurance credentialing for physicians, hospitals and a wide variety of other healthcare institutions. From start to finish, we will walk you through each step of getting approved with an insurance payer. Learn why countless healthcare professionals and organizations entrust us for medical insurance credentialing services.

At MedValue, we manage the complete provider credentialing lifecycle, from initial credentialing and re-credentialing to ongoing monitoring and maintenance. Our credentialing specialists ensure compliance with NCQA standards, CMS regulations, and individual payer requirements. Leveraging AI-driven document verification and OCR (Optical Character Recognition) tools, we expedite the primary source verification process for education, licenses, and malpractice history, significantly reducing errors and turnaround times. Clients benefit from real-time credentialing dashboards, proactive expiration alerts, and full visibility into the enrollment pipeline, ensuring faster onboarding and uninterrupted payer participation.

In today’s healthcare marketplace, the ability to accept potential patients’ insurance plans is essential for your practice’s success. Health insurance credentialing, also called provider insurance credentialing, is a process that medical insurance companies use so that you can apply for inclusion in their provider panels. If you wish to bill an insurance company as an in-network provider, you must undergo the credentialing process.

First, the insurance company you’re applying to will verify that you meet their internal requirements so that you can serve as an in-network provider on their panel. This could include your level of education, training and professional experience.

Once your practice or organization is credentialed with an insurance company, you can bill the payer directly. Also, many insurance companies offer providers other incentives, such as:

Referrals.
Inclusion in their web-based directories so consumers can locate you as a participating provider for your specific specialty.
Preferential reimbursement rates.

With Medvalue Healthcare, we help you get your applications completed twice as fast for Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, TRICARE and almost any other provider. Below are just a few functions we perform on your behalf throughout the credentialing process.

When considering which insurance companies you should be credentialed with, you must look at the major national plans, such as:

However, you also need to know which local insurance companies may be valuable. To determine this, consider asking a peer or another practice in your area which local health insurance companies best meet the needs of your patient base.

When you work with Medvalue Healthcare, we do extensive network research to ensure your practice or group includes the most varied, popular and effective insurance providers. We consider a variety of factors, including the top payers and your budget. We then follow up with you on this list until you give us the green light to go ahead.

Those establishing a private practice are often confused about insurance credentialing and procedures for billing third-party networks for their services.

The first step in setting up your revenue cycle is applying for credentialing and obtaining participating provider contracts with your chosen insurance companies. While this can be complicated, Medvalue Healthcare takes on this cumbersome process on your behalf. We provide you with guidance and industry know-how so that you can set up the revenue cycle for your new practice with ease.

Provider enrollment and insurance credentialing for government health programs such as Medicare, Medicaid and Tricare are a bit different. These programs have standardized forms that must be accurately filled out. They must then go to the appropriate intermediary who handles the administrative duties for the program in your jurisdiction.

Medvalue Healthcare understands these strict enrollment standards. We will take on this very detailed enrollment process so that your application has less risk of denial.

If you want to know how to get credentialed with insurance companies, please be aware that this process may take several months, and many insurance companies may not be accepting new providers on their panels. That’s why it pays to outsource this involved process. We provide professionals and organizations with extensive research and expertise to ensure we follow each payer’s guidelines, including:

We will help you submit a participating request to your chosen health plans using their specified credentialing application process. Once the health insurance company receives your credentialing application, employees perform a thorough verification process. Your file will then go to the company’s credentialing committee for approval. This process can take upwards of 90 days.

While this phase may feel drawn out, your dedicated Medvalue Healthcare account manager will provide you with weekly or even daily real-time application updates.

The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.

We help you through credentialing and also assist you with contracting negotiations before you sign your agreement, including: