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Credentialing & Provider Enrollment

Navigating the complex world of credentialing and provider enrollment can be overwhelming, but it’s essential to ensuring your practice’s success. Credentialing errors, enrollment delays, or lapses in participation can restrict patient access and impact revenue. Sorrell Young offers comprehensive Credentialing & Provider Enrollment Services designed to simplify the process, keeping your providers credentialed, compliant, and ready to serve patients. Let us handle the details while you focus on delivering high-quality care.

OVERVIEW

Credentialing and provider enrollment are essential for practice growth and sustainability, and with Sorrell Young, you’re partnering with a team that understands every detail. From initial credentialing to contract negotiation, we make sure your providers are ready to see patients without delays or disruptions. Our services keep you compliant, in-network, and ready to serve your community.

FOCUS AREAS

Initial credentialing, provider enrollment, recredentialing and maintenance, and CAQH profile management.

OUR PROCESS

What To Expect

01 Initial Consultation + Customized Plan

We start with a free consultation to understand your practice’s unique needs. Based on our discussion, we create a tailored credentialing and enrollment plan that outlines required documents, timelines, and payer specifics.

02 Application Submission + Follow-Up

Our team handles all aspects of application preparation, submission, and follow-up. We collect your documents, manage CAQH profiles, and communicate directly with payers to track progress and address any issues.

03 Ongoing Support + Recredentialing Maintenance

Credentialing doesn’t end with approval. We provide ongoing support, managing recredentialing schedules, CAQH updates, and any additional payer requirements, ensuring your credentials remain active and compliant.

Success Stories

  • “Sorrell Young was a lifesaver for our practice. We were struggling with credentialing delays that were affecting both our revenue and patient satisfaction. Their team stepped in, streamlined the entire process, and secured better contract terms than we had before. Thanks to their expertise, we’re now fully credentialed, have expanded our insurance networks, and can finally provide care to all the families who rely on us. We couldn’t be happier!”

    — Maria L, MD

PACKAGE OPTIONS

Package Information

01 BASIC

Solo providers or small practices looking to establish initial payer credentials.

  • ⟡ Initial credentialing with up to 3 insurance payers
    ⟡ Application preparation and submission
    ⟡ CAQH profile setup and management
    ⟡ Payer follow-ups until approval

    • Add-On: Recredentialing support for $250 per provider, per occurrence

02 STANDARD

Practices with multiple providers needing comprehensive credentialing and ongoing enrollment support.

  • ⟡ Initial credentialing with up to 5 insurance payers per provider
    ⟡ CAQH profile setup, management, and updates
    ⟡ Provider enrollment in Medicare and Medicaid
    ⟡ Application submission and regular follow-ups

    ⟡ Recredentialing reminders and support

    Add-On: Ongoing enrollment maintenance for $200/month per provider

04 CUSTOM

Practices with unique needs or specialty-specific payers, or those requiring customized enrollment solutions..

  • ⟡ We develop a tailored credentialing and enrollment plan to meet the specific requirements of your practice, including additional payer applications, specialty credentialing, and unique contract negotiations.

    Add-On: Flexible maintenance and recredentialing options available

03 PREMIUM

Larger practices and specialty clinics that require full-service credentialing, and compliance support.

  • ⟡ Initial credentialing with up to 8 insurance payers per provider
    ⟡ Comprehensive CAQH profile management and monthly updates
    ⟡ Medicare and Medicaid enrollment
    ⟡ Annual compliance and credentialing audit

    Add-On: Ongoing compliance and recredentialing for $350/month per provider

05 ADD-ON

Solo providers or small practices looking to establish initial payer credentials.

  • ⟡ Additional Payer Credentialing
    ⟡ Emergency Expedited Credentialing
    ⟡ Recredentialing Tracking & Management

    • Add-On: Recredentialing support for $250 per provider, per occurrence

WE GET REAL RESULTS

Featured Case Study

  • HLP is a growing pediatric practice dedicated to providing comprehensive care to children in the San Diego area. After adding a new provider, the clinic faced challenges in securing timely credentialing and enrollment with insurance carriers, leading to restricted patient access and significant revenue loss. Delays in credentialing also resulted in patient frustration, as many families were unable to use their preferred insurance for care. HLP reached out to Sorrell Young for help in overcoming these issues and achieving fast, accurate credentialing.

  • To address these challenges, we designed a Custom Credentialing & Provider Enrollment Package for HLP, focusing on expediting the enrollment process and ensuring smooth participation with major payers.

    1. Accelerated Initial Credentialing:

    • Action: We fast-tracked the new provider’s credentialing with top payers, completing applications, gathering required documents, and following up with carriers regularly to ensure timely processing.

    • Result: New provider credentialing was completed in 50% less time, allowing HLP to bill insurance carriers and serve a broader patient base sooner.

    2. CAQH Profile Management and Maintenance:

    • Action: We set up and managed CAQH profiles for all providers, updating them regularly to meet payer requirements.

    • Result: HLP saw a 30% improvement in payer responsiveness, as up-to-date profiles ensured faster approvals and fewer delays in enrollment.

  • After partnering with Sorrell Young, HLP experienced substantial improvements in both operational efficiency and financial performance:

    • 50% Faster Credentialing Approvals: Reduced credentialing time for new providers, allowing the practice to begin billing more quickly.

    • 30% Improved Payer Responsiveness: With CAQH profile management, the clinic experienced fewer delays in enrollments and re-credentialing.

Frequently Asked Questions

  • Credentialing is the process of verifying a healthcare provider’s qualifications and professional background to ensure they meet the standards required by insurance payers and regulatory bodies. It is essential for billing insurance companies, expanding your patient base, and securing in-network status, which enables patients to use their insurance for care at your practice. Without proper credentialing, you may face revenue limitations and miss out on a larger patient pool.

  • Credentialing typically takes between 60 to 120 days, depending on the specific payer and provider’s background. Factors such as the provider’s experience, specialty, and the payer’s internal processing time can affect this timeline. At Sorrell Young, we expedite the process by handling follow-ups and tracking applications closely to minimize delays.

  • The documents required may vary by payer but generally include copies of your state license, DEA certificate, board certifications, liability insurance, education and training records, and a completed CAQH profile. We provide a checklist and guide to ensure you have all necessary documents ready for a smooth credentialing process.

  • The Council for Affordable Quality Healthcare (CAQH) is a central database that allows providers to store their credentialing information, which payers can access to streamline the credentialing process. Maintaining an up-to-date CAQH profile can significantly speed up approvals and make recredentialing easier. Sorrell Young Co. manages CAQH profiles for our clients, keeping them accurate and updated for payer access.

  • Yes, re-credentialing is typically required every two to three years by most insurance payers. Re-credentialing ensures that your providers’ credentials remain valid and up-to-date, helping to avoid disruptions in payer participation and reimbursement. Our team proactively manages re-credentialing schedules, so you stay compliant and in-network.

  • Credentialing is the verification of a provider’s qualifications, while enrollment is the process of formally registering that provider with insurance payers so they can bill for services. Credentialing must be completed before enrollment can proceed. Our services cover both processes to ensure your providers are fully credentialed and enrolled, ready to serve patients.

  • If an application is denied, we work to identify the cause and correct any issues. Our team will communicate directly with the payer to resolve discrepancies, missing information, or misunderstandings and resubmit the application to secure approval as quickly as possible.

  • Our ongoing support includes recredentialing, CAQH profile updates, tracking of recredentialing deadlines, and management of compliance requirements. We also offer dedicated support to help resolve any credentialing-related issues that may arise, ensuring that your providers remain active and in-network.

Get Started

Take the hassle out of credentialing and provider enrollment with our expert support. Let Sorrell Young streamline your credentialing process, expand your payer network, and help you achieve sustainable growth. Contact us today for a free consultation to find the right credentialing solution for your practice.