Frequently Asked Questions

Provider credentialing is the process of verifying a healthcare provider's qualifications, including education, training, licensure, and work history. It's required for providers to participate in insurance networks and receive reimbursement for services rendered to insured patients.

The credentialing timeline varies by payer. On average, commercial insurance credentialing takes 60-120 days, Medicare enrollment takes 60-90 days, and Medicaid enrollment can take 30-90 days depending on the state. Our team works to expedite the process by ensuring complete and accurate applications from the start.

CAQH (Council for Affordable Quality Healthcare) ProView is a universal provider database used by most insurance companies during the credentialing process. Maintaining an up-to-date CAQH profile is essential because many payers pull your information directly from CAQH when processing your application. We help set up and maintain your CAQH profile.

Yes, we handle the complete Medicare (PECOS) and Medicaid enrollment process, including initial applications, revalidations, change of information updates, and adding new practice locations. We ensure all documentation meets CMS requirements to avoid delays.

If an application is denied, we review the denial reason, gather any additional required documentation, and submit an appeal or corrected application. Common denial reasons include incomplete applications, expired documents, or discrepancies in reported information — all issues we proactively address during the initial submission.

You only need to be credentialed with the insurance companies whose patients you want to see in-network. We help you identify which payers are most common in your area and patient population, then prioritize those applications to maximize your revenue potential.

Re-credentialing is the periodic verification of a provider's credentials, typically required every 2-3 years depending on the payer. We track all re-credentialing deadlines and proactively manage the process to ensure continuous network participation without gaps.

Our medical billing services include charge entry, claim submission (electronic and paper), payment posting, denial management, accounts receivable follow-up, patient statement generation, and detailed financial reporting. We provide end-to-end revenue cycle support tailored to your practice.

We have a structured denial management process: we identify the denial reason, correct any errors, gather supporting documentation, and resubmit or appeal the claim within the payer's timely filing deadline. We also track denial patterns to implement preventive measures and reduce future denials.

We work with a wide range of healthcare specialties including primary care, mental health, physical therapy, chiropractic, dermatology, cardiology, orthopedics, and more. Our team understands specialty-specific coding requirements and payer guidelines.

Most practices see measurable improvement within 60-90 days of onboarding. This includes reduced claim denials, faster payment turnaround, and improved collections on outstanding balances. We provide monthly reports so you can track progress.

Yes, we manage patient billing including generating statements, processing patient payments, setting up payment plans when appropriate, and handling patient billing inquiries. We ensure a professional, compassionate approach to patient collections.

We work with most major practice management and EHR systems. During onboarding, we assess your current systems and either integrate with your existing platform or recommend solutions that best fit your practice's needs and workflow.

Our insurance verification process confirms patient coverage status, verifies benefits and copay/coinsurance amounts, checks deductible status, confirms prior authorization requirements, and identifies any coverage limitations or exclusions — all before the patient's appointment.

We recommend verifying insurance eligibility 48-72 hours before the scheduled appointment. This allows time to address any issues, obtain necessary authorizations, or notify patients of coverage changes before they arrive at your office.

If we discover inactive coverage, we immediately notify your front desk team so they can contact the patient before their appointment. This prevents unexpected billing issues and gives patients time to provide updated insurance information or arrange alternative payment.

Yes, we manage the prior authorization process including identifying which services require authorization, submitting requests with supporting clinical documentation, following up on pending authorizations, and tracking approval status to prevent service delays.

Getting started is simple: schedule a free consultation through our website or call us at (305) 786-4001. We'll discuss your practice's needs, assess your current workflows, and create a customized plan. Onboarding typically takes 1-2 weeks depending on the services you need.

Yes! While we're based in Miami, Florida, we serve healthcare providers nationwide. Our services are performed remotely, allowing us to support practices in any state with the same level of dedicated, personalized attention.

Our team is trilingual — we communicate fluently in English, Spanish, and Portuguese. This allows us to serve diverse healthcare communities and ensure clear communication with providers, staff, and patients regardless of language preference.

We're a boutique healthcare operations partner, not a large impersonal corporation. Every practice gets a dedicated account manager, personalized communication, and solutions tailored to their specific needs. We treat your practice as a valued relationship, not just an account number.

Our pricing varies based on the services you need and your practice's volume. We offer transparent, competitive pricing with no hidden fees. Contact us for a free consultation and customized quote based on your specific requirements.

Absolutely — our services are modular. You can choose credentialing only, billing only, insurance verification, or any combination that fits your needs. Many practices start with one service and expand as they see results.