Credentialing Services

At Optifisc Solutions, we offer comprehensive credentialing services to ensure healthcare providers meet payer requirements, maintain compliance, and prevent reimbursement delays. Our expert team manages the entire credentialing process efficiently, allowing providers to focus on patient care.

Gather essential provider details, including personal and professional information.
Verify credentials such as NPI, CAQH, DEA, and malpractice insurance.
Ensure education, training, board certifications, and licenses are up to date.

Primary Source Verification (PSV)

Conduct background checks and verify provider credentials with authoritative sources.
Confirm medical school degrees, residency, work history, and board certifications.
Ensure compliance with NCQA, CAQH, and CMS guidelines.

Insurance & Payer Enrollment

Assist providers in enrolling with Medicare, Medicaid, and commercial insurance payers.
Prepare and submit credentialing applications accurately and on time.
Follow up with payers to expedite approval and prevent delays

Contracting & Fee Schedule Negotiation

Assist in negotiating payer contracts to maximize reimbursement rates.
Review fee schedules and recommend adjustments for fair compensation.
Ensure providers receive timely reimbursements without underpayments.

Re-Credentialing & Compliance Management

Monitor expiration dates for licenses, certifications, and contracts.
Manage re-credentialing and revalidation to prevent claim denials.
Ensure compliance with HIPAA, Medicare, and payer-specific requirements.

Documentation & Secure Record Management

Maintain digital credentialing files for quick access and audits.
Ensure accurate documentation to reduce claim rejections.
Keep credentialing profiles updated with insurance payers.

Ongoing Maintenance & Support

Provide real-time updates on credentialing application status.
Act as a liaison between providers and insurance companies.
Offer continuous support to prevent enrollment lapses and revenue disruptions.

Provider Information Collection

Fast & Accurate Credentialing – Reduce administrative delays and start billing sooner.
End-to-End Payer Enrollment – From application submission to approval, we handle everything.
Maximized Reimbursements – Secure optimal contract terms and prevent revenue loss.
Full Compliance Management – Stay compliant with industry regulations effortlessly.

Why You Choose Optifisc Solutions for Credentialing?

At Optifisc Solutions, we simplify the complex credentialing process so you can focus on patient care while we handle the paperwork. Let us take care of your credentialing needs with precision and efficiency!