Provider Enrollment & Credentialing

Provider Enrollment and Credentialing can be a cost-effective solution for providers enabling in-network payment for patient services. Unfortunately, making it happen can be a time-consuming challenge. Advantum’s Provider Enrollment Service team specializes in facilitating the process to ensure prompt payments and reimbursements. We manage your end-to-end PES needs including documentation, enrollment, payer portals, revalidation and more. 

Provider Enrollment Services (PES)

• Contract negotiations
• Commercial insurance enrollments and credentialing
• Medicare and Medicaid enrollment and credentialing
• Medicare and Medicaid Revalidation
• CAQH Registration & Maintenance
• NPI Registration (Type I and Type II) 
• PECOS

Benefits

• Reduced administrative burden and costs
• Expedited payer enrollment with complete and accurate information
• Reduced denials
• Increased reimbursements 

How it Works

Our team reviews and assures that we have all the right documentation before submitting your information to the payer. We confirm that all licenses, certifications, group names, Medicare/Medicaid TINs, malpractice insurance and more are accurate across all paperwork so your application gets accepted the first time. We manage your initial enrollment and maintain your information on CAQH. Our team informs you when your information requires re-enrollment or is expiring. We are your advocate and liaison with your payers.

On-going Monitoring 

Advantum Health knows that while setting up and getting credentials approved is critical – it’s even more important to monitor the outcome. Our experts work closely with your back-office staff to monitor for claim status and denials. We review denial status and reason codes and look at your original contracts to make sure you are getting paid properly.

At Advantum Health, we believe that your revenue cycle is not a static process but rather an evolving, dynamic process that needs constant attention for the success of your business, your practice – and ultimately, the care of your patients.