Provider Credentialing Services That Simplify Compliance

Credentialing delays can lead to missed reimbursements, compliance risks, and operational inefficiencies. SolvEdge simplifies the credentialing process with end-to-end services, including CAQH profile updates, commercial payer enrollment, and state licensing. Our solutions ensure your practice remains compliant while you focus on delivering exceptional patient care.

  • ✓ Streamline Enrollment
  • ✓ Reduce Onboarding Time
  • ✓ Maximize Reimbursements
Credentialing dashboard showing CAQH and payer enrollment status
Credentialing dashboard showing CAQH and payer enrollment status

The Challenge of Provider Credentialing

  • Missed reimbursements due to incomplete applications
  • Long onboarding times with commercial and federal payers
  • Complex licensing and compliance requirements

The SolvEdge Advantage

At SolvEdge, we streamline every step of the credentialing process with advanced technology and expert support, helping you onboard faster and maximize reimbursements.

Our Comprehensive Credentialing Services

Struggling with claim denials?
Here’s how it impacts healthcare organizations:

CAQH Profile Updates

  • Ensure your CAQH profile reflects the latest licensure, malpractice insurance, and certifications.
  • Automate profile updates to avoid delays with payers.

Commercial and Federal Credentialing

  • Seamlessly onboard with top insurers like Aetna, Cigna, and Medicare/Medicaid.
  • Expert negotiation of payer contracts to secure optimal terms and reimbursement rates.

State Licensing and DEA Certification

  • End-to-end support for state license applications and renewals.
  • U.S. DEA certification assistance for prescribing controlled substances.

CLIA Registration

  • Guidance on Clinical Laboratory Improvement Amendments (CLIA) compliance for laboratory services.

Easier Credentialing Workflow: Ensuring Compliance and Efficiency in Provider Enrollment

1

Gather Provider Information

Collect essential documents such as medical licenses, board certifications, DEA registration, malpractice insurance, and a current CV from the healthcare provider to initiate the credentialing process.

2

Verify Credentials

Authenticate submitted documents by cross-referencing with primary sources like state medical boards, the National Practitioner Data Bank (NPDB), and OIG exclusion lists to ensure validity and compliance.

3

Submit Applications

Prepare and submit detailed credentialing applications, including all required documents, to insurance payers such as Medicare, Medicaid, and private insurers for enrollment.

4

Payer Review

Payers evaluate applications over 30-90 days, verifying provider qualifications, credentials, and adherence to regulatory standards before granting approval.

5

Negotiate Contracts

After approval, negotiate reimbursement rates, contract terms, and conditions with payers to establish mutually agreeable provider contracts.

6

Enrollment Approval

Receive formal confirmation of enrollment from payers, including issuance of provider IDs like the National Provider Identifier (NPI) or payer-specific IDs.

7

Update Systems

Input approved provider details into the practice's billing and electronic health record (EHR) systems to facilitate accurate claim submissions and patient care tracking.

8

Ongoing Monitoring

Conduct periodic re-credentialing (every 1-3 years) and continuously monitor license renewals, exclusion lists, and payer policy updates to maintain compliance.

What Sets SolvEdge
Apart?

images
images
images
images

Client Testimonials

“SolvEdge reduced our onboarding time by 40%, allowing us to focus on patient care. Highly recommended!”

Dr. Smith
Medical Group Practice

Ready to Streamline Credentialing?

Discover why hundreds of healthcare providers trust SolvEdge for efficient, compliant, and scalable credentialing solutions.

FAQ – SolvEdge Provider Credentialing

  1. Provider credentialing involves verifying a healthcare provider’s qualifications, such as state licensing, DEA certification, and malpractice insurance.
  2. Privileging refers to the specific services or procedures a provider is allowed to perform within a healthcare facility after credentialing is complete.
  3. Credentialing ensures compliance with payer and regulatory bodies, while privileging focuses on clinical competency.
  4. Credentialing impacts payer enrollment and reimbursements, privileging affects internal hospital operations.
  5. SolvEdge’s credentialing services streamline this by separating documentation collection and application submission for each process.

  1. Individuals with experience in healthcare credentialing services, provider data management, or payer relations are eligible.
  2. Familiarity with CAQH updates, payer enrollment, and compliance standards is essential.
  3. Understanding of state licensing services, DEA certification, and CLIA compliance adds value.
  4. Candidates often support processes like re-credentialing, document tracking, and contract negotiation.
  5. SolvEdge supports organizations with expert support and advanced technology to assist certified credentialing specialists.

  1. Licensure and certifications (e.g., state licenses, DEA certification, malpractice insurance).
  2. Detailed work history and education, ensuring eligibility for payer enrollment.
  3. Active and verified CAQH profile, with consistent CAQH updates and attestations.
  4. SolvEdge's credentialing services assist in collecting and managing this data with AI-assisted tools.
  5. Keeping these elements updated ensures compliance, shortens processing time, and improves reimbursement cycles.

  1. Application submission including credential data, state licensing, and malpractice insurance.
  2. Primary source verification, including CAQH profile updates and payer checks.
  3. Payer enrollment processing, contract review, and approval.
  4. Ongoing re-credentialing to maintain compliance and payer eligibility.
  5. SolvEdge supports every stage with end-to-end credentialing services that reduce onboarding time and boost reimbursements.

  1. It's commonly known as provider credentialing, a requirement by both commercial payers and federal payers.
  2. Mandatory for payer enrollment, to qualify for reimbursement of services.
  3. Includes verifying licensure, certifications, and submitting to CAQH.
  4. SolvEdge offers healthcare credentialing services to handle this complex, mandatory process.
  5. Our AI-assisted tools automate submissions and reduce the chance of credentialing delays missed reimbursements.

  1. Providers must revalidate their Medicare credentials every 3 to 5 years.
  2. This includes updating CAQH, state licensing, and other essential credentialing services data.
  3. Failure to revalidate may disrupt payer enrollment and delay reimbursements.
  4. SolvEdge provides re-credentialing reminders, document tracking, and compliance updates.
  5. We help providers avoid credentialing delays with scalable credentialing solutions and expert support.

  1. The CAQH database stores provider credentials for payer enrollment and network participation.
  2. It allows payers to access verified data, helping reduce onboarding time and improve processing time.
  3. Maintaining CAQH updates is essential to ensure compliance and avoid delays in reimbursement.
  4. SolvEdge helps automate CAQH profile updates and reduce paperwork.
  5. Our credentialing services ensure providers stay active with insurers and maximize reimbursements.

  1. CAQH profile re-attestation is required every 120 days to stay current.
  2. Regular CAQH updates help prevent credentialing delays missed reimbursements.
  3. SolvEdge's platform can automate CAQH profile updates and send timely alerts.
  4. This supports compliance with payer requirements and avoids disruptions in payer enrollment.
  5. Our healthcare credentialing services handle document tracking, submissions, and profile accuracy.

  1. We offer full payer enrollment services, from application to contract negotiation.
  2. Our system reduces onboarding time, improves compliance, and enhances reimbursement timelines.
  3. SolvEdge handles CAQH updates, credentialing submissions, and manages state licensing services.
  4. With AI-assisted tools, we eliminate operational inefficiencies and processing time.
  5. Our provider credentialing services ensure seamless onboarding with both commercial and federal payers.

  1. Yes, SolvEdge offers state licensing services tailored to individual state regulations.
  2. We provide end-to-end support for state license applications across all U.S. states.
  3. Our experts manage DEA certification, malpractice insurance, and CLIA compliance.
  4. Our credentialing services simplify document collection and ensure timely approvals.
  5. With advanced technology and expert support, we ensure full compliance for healthcare providers across states.