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Credentialing and Payer Management Services

A crucial component of any health organization is the management of Provider and Facility credentialing, monitoring, and maintenance. Credentialing is the process of reviewing a health professional’s credentials to determine if privileges to practice can be granted. Enrollment is the process of enrolling a health professional in contracts required by payors for reimbursement for medical services and/or products provided. Both credentialing and enrollment activities are critical to an organization’s financial performance.

Credentialing and Enrollment Overview

  • Credentialing is the process of reviewing healthcare practices and practitioners to determine if they meet the criteria for payor enrollment and medical privileging. The process involves collecting all current and background data, including accreditations, licensing, education, training, certifications, and work experiences.
  • Privileging is obtaining hospital or medical facility approval for a healthcare practitioner to perform procedures based on knowledge demonstration and competency.
  • Enrollment is the process of enrolling healthcare practices and practitioners in contracts required by payors for reimbursement for medical services and/or products provided.

Credentialing activities are critical to an organization’s financial performance. Let us ensure your credentialing privileges and practitioner enrollment process moves along efficiently and timely.

Proprietary Cloud-Based Software

  • Maintains credentialing compliance
  • Tracks expiration dates and renewals
  • Provides visibility into provider status

enrollment Licensure & Education Other Services Privileges Facility enrollment

Avoid common mistakes as a result of the following challenges:

  • The absence of standardized requirements between payors adds complexity and time
  • Lack of available resources with regulatory and accreditation experience
  • Rules, regulations, laws and statutes vary across state and federal levels
  • Mistakes in credentialing and license expirations can result in financial loses

At SYNERGEN Health, we ease the burden of credentialing. Our 100+ combined years of credentialing experience in the medical field allow us to streamline the paperwork and eliminate any errors that can keep you from getting properly credentialed and contracted with payors and medical facilities.


Service of Excellence

We are committed to the personalized service we provide to our clients and value those relationships. We get to know your practice inside and out, partnering with you so that we fully understand your unique services and needs.

We use KPI's to measure performance and quality

  • Payer enrollment denial, completion, and approval percentages.
  • Total application processing time.

With SYNERGEN Health Credentialing Services, you get:

Point of Contact

Dedicated, experienced account manager, sole point of contact

Updated Regulations

Updated governmental / commercial changes in rules and regulations

Notifications

Notifications of governmental / commercial expiration / renewal dates

Reduced Errors

Reduced number of errors and rejections due to credentialing enrollment and missed expirations

Case Studies

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