Credentialing Solutions
Simplify Enrollment, Boost Reimbursement, and Stay Compliant
At Keystone Medics, we deliver expert Medical Credentialing Services designed to help healthcare providers smoothly navigate the complexities of insurance enrollment. Our dedicated team ensures your practice is properly credentialed with all major payers, minimizing reimbursement delays and safeguarding your revenue cycle from costly interruptions.
Keystone Medics Offers Customized Credentialing Services
Keystone Medics Credentialing Essentials
Keystone Medics provides end-to-end credentialing services to accelerate the provider enrollment process, reducing claim delays and saving valuable time and resources. In delivering our credentialing and enrollment solutions, Keystone Medics consistently takes the following key factors into account:
Keystone Medics Top 5 Credentialing Steps
Application Submission
The provider submits a detailed application with personal, educational, and professional information.
- Medical licenses
- DEA certification
- Board certifications
- CV/resume
- Malpractice insurance
- References
Primary Source Verification
The credentialing organization verifies the provider's information directly from original sources, such as:
- Medical schools & residency programs
- State medical boards
- Past employers
- National Practitioner Data Bank (NPDB)
Committee Review
A credentialing committee (e.g., hospital or health plan committee) reviews the provider's documents.
Evaluates qualifications, experience, and any red flags (e.g., malpractice claims, gaps in employment)
Approval & Privileging
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If approved, the provider is granted medical staff membership.
Privileging determines the specific services the provider can perform within the facility
Ongoing Monitoring & Re-Credentialing
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Credentials must be renewed every 1-3 years (depending on the organization).
Continuous monitoring for any disciplinary actions or changes in license status.
Key Advantages of Provider Credentialing Services
Maintain Updated Payer Data
Ensure your provider information is current with all insurance payers to avoid delays in reimbursements and approvals.
Accelerate Insurance Payments & Boost Referrals
Streamline credentialing to speed up claim processing and enhance your network visibility for more patient referrals.
Strengthen Payer Relationships
Foster strong connections with multiple payers to expand your practice’s network and reimbursement opportunities.
Track Credentialing in Real Time
Monitor the status of enrollment and credentialing submissions instantly for better transparency and efficiency.
How long new Practice / Provider enrollment takes to be done?
It typically takes 120 days for a new provider or group to receive their full credentialing. It can take 30 to 60 days for certain payers, and up to 150 days for others.
When will services for credentialing be accessible?
Within three business days of receiving the proposal and credentialing documents, your enrollment procedure will begin.
What are the benefits of using a medical billing company with a dedicated credentialing department?
Access to experienced professionals who specialize in credentialing Streamlined processes and improved efficiency Reduced administrative burden for your practice Increased revenue and improved cash flow Enhanced compliance with payer regulations.
What type of documentation is required for credentialing & Enrollment?
Document Required for Individual Provider:
State License
Certificate of Malpractice Insurance (COI)
Federal DEA License
State DEA License (CDS License; if required by state)
Board Certification(s)
Current CV (use MM/YYYY format; show current employer)
Driver’s License
Diploma (highest level of education)
ECFMG Certificate (for providers educated outside the United States; Educational Commission for Foreign Medical Graduates)
Collaborative Agreement (required for Nurse Practitioners only)
Prescribing Arrangement Letter (for providers not holding federal DEA License)
Admitting Arrangement Letter (for providers who do not have active hospital admitting privileges)
Legal entity documents (copies only for license and certificate requirements):
State Business License
Certificate of Malpractice Insurance (COI)
CLIA Certificate (if applicable; Clinical Laboratory Improvement Amendments of 1988)
IRS W-9 Form
IRS Form CP575 or replacement letter 147C (verification of EIN/TIN)
Bank Account Verification Letter or a copy of the voided check