Provider Credentialing & Enrollment Services
Complete medical credentialing, re-credentialing, and provider enrollment services for healthcare providers across the United States.
PlusMed Solutions offers complete medical credentialing, re-credentialing, and provider enrollment services for healthcare providers, group practices, and medical organizations across the United States. Our expert team ensures providers are properly credentialed, enrolled, and electronically connected with insurance payers to prevent claim denials, payment delays, and revenue loss.
Medical Credentialing Services
Our provider credentialing services verify healthcare professionals' qualifications and secure participation with Medicare, Medicaid, and commercial insurance companies. We manage the entire credentialing process to ensure accuracy, compliance, and timely approvals.
New Provider Credentialing
We provide full credentialing support for physicians and non-physician providers, individual and group medical practices, and new and expanding healthcare organizations.
- Medicare and Medicare Advantage plans
- State Medicaid programs
- Commercial and private insurance carriers
- Managed care organizations (HMO/PPO)
Primary Source Credential Verification
We conduct complete primary source verification in accordance with payer and regulatory requirements, ensuring compliance and reducing credentialing delays.
- State medical licenses
- Board certifications
- Education and training history
- Work experience and affiliations
- DEA registration (when applicable)
- Professional liability insurance
CAQH Profile Setup and Management
PlusMed Solutions creates, updates, and maintains CAQH provider profiles, ensuring accurate provider data, timely attestations, and required document uploads. Proper CAQH management speeds up payer credentialing approvals and reduces follow-up requests.
Insurance Payer Application Submission
Our team prepares and submits all credentialing applications, ensuring payer-specific requirements are met. We communicate directly with insurance companies and track applications until final approval is received.
Re-Credentialing Services
Insurance payers require providers to complete re-credentialing every 2 to 3 years. Missed deadlines can lead to claim denials and payment suspension. PlusMed Solutions manages re-credentialing proactively to ensure uninterrupted reimbursement.
Credential Expiration Tracking
We monitor credentialing and revalidation timelines to initiate re-credentialing well before expiration dates.
Information Review and Updates
We review and update provider demographics, licenses and certifications, malpractice insurance, and practice locations and affiliations.
Re-Credentialing Submission and Follow-Up
Our team submits re-credentialing applications and follows up with payers until continued participation is confirmed.
Provider Enrollment Services
Our provider enrollment services ensure healthcare providers are authorized to submit claims and receive payments from insurance payers.
Medicare, Medicaid & Commercial Enrollment
- Medicare and Medicare Advantage plans
- State Medicaid programs
- Commercial insurance companies
- Workers' compensation and specialty payers
Individual and Group Enrollment
- Individual provider enrollment
- Group practice enrollment
- Linking providers to group NPIs and tax IDs
NPI Registration and Updates
- New NPI applications
- NPI updates and corrections
- Linking NPIs to payer enrollment records
ERA, EDI & EFT Enrollment Services
PlusMed Solutions provides full electronic enrollment services to support faster claims processing and quicker payments.
EDI Enrollment (Electronic Data Interchange)
We enroll providers with clearinghouses and insurance payers for electronic claim submission.
- Secure and HIPAA-compliant data exchange
- Faster claim processing
- Reduced billing errors
ERA Enrollment (Electronic Remittance Advice)
We set up ERA enrollment so providers receive electronic explanation of benefits (EOBs).
- Faster payment posting
- Improved reconciliation accuracy
- Reduced manual processing
EFT Enrollment (Electronic Funds Transfer)
Our team completes EFT enrollment so insurance payments are deposited directly into your bank account.
- Faster reimbursements
- Improved cash flow
- Elimination of paper checks
Banking Verification and Security
We ensure all banking details are securely handled and payer verification requirements are completed accurately to prevent enrollment delays.
Key Benefits
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With PlusMed Solutions, healthcare providers gain a reliable partner dedicated to accurate credentialing, timely re-credentialing, and seamless payer enrollment, ensuring consistent revenue and compliance.
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