Credentialing/Enrolment
Credentialing/Enrolment
Credentialing
Payer Application Management
Primary Source Verification
Taxonomy & Group Updates
Seamlessly onboard providers with our comprehensive credentialing and enrollment service. At Emerger RCM, we eliminate delays and denials by ensuring timely, accurate credentialing, payer enrollment, and paperwork management—so your practice can focus on patient care.
Credentialing
Our credentialing service ensures providers are formally vetted and approved by payers before delivering care. We manage the full credentialing lifecycle: gathering provider credentials, completing application packets, and following up with payers until approval.
This includes re-credentialing and primary source verification of licenses, education, work history, and malpractice history. We track every deadline and submission, minimizing gaps in provider status and preventing claim denials.
Enrollment
Enrollment ensures providers are officially recognized by insurance networks and ready to submit claims. We handle payer-specific enrollment forms, fee payments, and CMS enrollment (e.g., CAQH, PECOS). Our team conducts eligibility verification, monitors payer portals, and confirms effective dates. By regularly auditing enrollments and updating group taxonomies or reassignments, we reduce claim rejections, accelerate reimbursements, and enhance your practice’s network reach.
Contact us today to learn more about our team
We would be happy to answer any questions you may have or provide you with additional information about our services.
Primary Source Verification
We verify credentials licenses, education, malpractice, work history directly with issuing bodies to ensure payer compliance.
Payer Application Management
From MA, BCBS to United, we complete and submit all payer credentialing & enrollment forms with accuracy and speed.
CAQH & PECOS Setup
We initiate and maintain CAQH and CMS credentials, ensuring up-to-date provider data and reducing re-verification delays.
Taxonomy & Group Updates
We manage and update taxonomy codes, NPI, group affiliations, and reassignment forms to reflect your practice structure.
Payer Follow-up & Appeals
We actively track application status, address deficiencies, and submit appeals so credentialing and enrollment clearances are timely.
Re-Credentialing Reminders
Our system tracks credential expiry and triggers alerts 120/60/30 days prior, so no deadlines are missed.
Emerger RCM takes ownership of the entire credentialing lifecycle, from initial application to re-credentialing. Once we collect provider credentials such as licensure, DEA registrations, education, malpractice insurance, and work history we assemble a complete, payer-compliant packet. Each application is carefully reviewed against payer guidelines before submission.
We actively monitor the process, responding to requests for additional documentation, and escalate incomplete applications to ensure timely credentialing. This proactive stewardship minimizes credentialing gaps, protects your reimbursement stream, and allows your staff to stay focused on patient care.
Joining insurer networks is essential for providers to bill and collect payment. We guide each provider through payer-specific enrollment processes, handling forms, payer credentialing fees, group reassignment, and specialty approvals. We initiate CAQH attestations and CMS PECOS profiles where required, ensuring all data is verified and current.
Post-enrollment, we confirm effective dates and update your practice system accordingly. By maintaining direct communication with payer credentialing departments, we reduce wait times, manage denials quickly, and secure faster payor access for your team.
Maintaining accurate national enrollment profiles is vital for network access. Our team handles CAQH profile setup, reattestations, and periodic updates to provider data reducing manual follow-ups and credentialing delays. For Medicare/Medicaid enrollments, we manage CMS PECOS filings, including NPPES NPI updates and assignment of benefits forms.
We continuously monitor revalidation deadlines, submit timely updates, and ensure provider updates reflect in payer systems. This consistent oversight prevents disruptions, claims rejections due to expired credentials, and supports ongoing reimbursement.
Credential expirations can lead to claim denials if unattended. Our system tracks all license, certification, and enrollment expiry dates and initiates reminders at strategic intervals typically 120, 60, and 30 days prior. When deadlines approach, we notify your team and begin re-credentialing workflows.
This proactive approach prevents coverage disruption and ensures compliant provider status. Our transparent dashboard allows you to view credential timelines at a glance, giving you control and clarity, while reducing administrative burden and financial risk.
Your data security and regulatory compliance are paramount. Emerger’s credentialing and enrollment processes are handled within HIPAA-secure systems, including encrypted document transmissions, secure portals, and role-based access control. Staff undergo regular compliance training and operate under strict confidentiality policies.
Our audit trails log every action downloads, submissions, attestations so we can demonstrate compliance at any time. By partnering with us, you reduce organizational risk, strengthen accreditation efforts, and protect both provider and patient data integrity.
