Credentialing is how a provider gets approved by insurance payers and hospitals to see their patients and be paid for it. Doctor Rebrand handles the whole process for individual providers and groups: the applications, CAQH, the follow-up calls, and every re-credentialing and revalidation after you are approved.
What's Included
Payer Enrollment
- Commercial payers, including Aetna, Blue Cross Blue Shield plans, Cigna, UnitedHealthcare, Humana and regional plans.
- Medicare enrollment through PECOS, or a Medicare opt-out for cash-pay practices that need one.
- Medicaid and Medicaid managed care plans in your state.
- Individual and group enrollment, with each provider linked to the group.
- A payer plan: which networks are open in your area and worth joining.
CAQH and Provider Data
- Your CAQH ProView profile built, completed and attested.
- Re-attestation every 120 days, so your profile never lapses.
- Licenses, DEA, board certification, malpractice and work history kept current in one record.
- Individual and organizational NPI registration and updates.
Hospital Privileges
- Hospital and surgery center privileging applications.
- Documents, references and case logs gathered for each committee.
- Reappointment packets prepared before they come due.
Re-Credentialing and Maintenance
- Payer re-credentialing, usually every three years.
- Medicare revalidation every five years.
- Address, tax ID and new-location changes sent to every payer.
- Every expiration date tracked, with reminders well before anything lapses.
Stuck or Denied Applications
- Status follow-up with each payer until the application is decided.
- Exception requests and appeals when a panel is closed or an application is denied.
- Effective dates confirmed, so your first claims are paid.
How It Works
- 1
One Intake
You fill out one intake and send your documents once. We reuse them for every application.
- 2
Payer Plan
We confirm which payers are open in your area and agree on the list with you.
- 3
Applications
We complete and submit every application and follow up until each one is approved.
- 4
Maintenance
We re-attest, re-credential and revalidate on schedule, for as long as you are with us.