Manage the entire end-to-end enrollment process from submission to decision
Efficient Onboarding
Eliminate paperwork, manual workflows, and administrative burdens for the provider and your business through streamlined, electronic payer enrollment.
Faster Reimbursement
Reduce delays in claims processing and improve cash flow with Certify’s streamlined reimbursement process that enrolls and credentials providers more accurately, and in less time.
Compliance And Accuracy
Maintain compliance and mitigate risks more quickly. Certify’s system stays up-to-date with real-time provider credentials, licenses, certifications, and compliance statuses so you don’t have to.
We’ll handle the hassle of payer enrollment so you don’t have to
The administrative burden required to collect provider data, complete contracting applications, follow up with plans, and manage onboarding processes prevents you from focusing on what’s important, your mission. Certify optimizes each critical process by reducing manual interventions, automating key workflows, and trimming administrative costs.
Designed to simplify and optimize the onboarding and credentialing process
Credentialing Centralization And Management
Centralize the collection and verification of provider credentials, licenses, certifications, and compliance documentation. Ensure an accurate, compliant, and streamlined credentialing process for your business.
Real-Time Status Tracking
Enable real-time tracking of payer enrollment status to reduce administrative overhead, expedite processes, and improve transparency. So you can stay informed through every step of the application process, as well as any required follow-up.
Compliance Monitoring
Track the expiration dates of provider credentials, licenses, and certifications. Certify will automatically alert your organization of upcoming expirations, ensuring timely renewals and mitigating compliance risks.
Entity Provider Data Management
With Certify, upload, edit, and manage your organization and clinic-level details, including information such as Tax, Billing, and Address information along with storing the relevant documentation.
Get providers in-network and get reimbursed faster, so you can get back to care
Partner with an experienced CVO that’s NCQA-certified for 11 out of 11 verification services.
“Certify has a depth and breadth of payer/provider intelligence, which they make highly actionable for healthcare companies that need to achieve scale fast. The Certify team knows that in these times of tectonic shifts in American healthcare, swift and certain payer enrollment is a distinct competitive advantage.”
FREQUENTLY ASKED QUESTIONS:
What are the different elements and associated turnaround times of payer enrollment?
Payer Enrollment consists of two parts: contracting and credentialing. Contracting is the process of executing an agreement with the health plan. This is typically accomplished by submitting an application or request to join form on the health plan website. It takes an average of 30 to 45 days to receive a contract from the health plan once an application is submitted. Credentialing, which can happen either in parallel or sequentially with contracting, is the process by which the health plan will verify that each provider is compliant with the health plan's credentialing policies and prcocedures. This process typically takes between 60 to 90 days.
What is included as part of your payer enrollment service offering?
Certify will manage the entire end-to-end enrollment process from submission to approval or plan decision. With the best-in-class payer enrollment portal and efficient workflows, Certify will help clinics:
Manage the entire end-to-end enrollment process from submission to approval or plan decision
Reduce lengthy contracting timelines and lead to fewer rejections by submitting complete applications via streamlined workflows.
Receive market and plan-level insights from our in-house subject matter experts, so you can limit enrollment efforts to plans with favorable turn around times and sufficient capacity
Access full transparency and visibility. Providers will be able to track enrollment progress in real-time through the portal.
Follow up with payers to ensure applications are current and under consideration for approval
Keep track of the evolving healthcare requirements and ensure providers are in compliance
What lines of business are included?
Certify submits applications for all lines of business that are offered by the health plans. Some plans may have restrictions or requirements for specific lines of business based on their policies and procedures. In such instances, Certify will notify the client of these requirements are we become aware of them.
What is the process of getting a new group enrollment? How is it different from adding a new provider to an existing group?
A new group enrollment will need to go through both the contracting and credentialing parts of the enrollment process. As highlighted above, contracting is the process that consists of executing an agreement with the health plan at the organizational level, and credentialing is where the health plan will credential each provider that is requesting to join their network to that organization.
For any groups that are already contracted and enrolled with a health plan, adding a provider to an existing group does not require them to go through the contracting portion of enrollment. Since a contract already exists on the group entity level, the provider will just need to be credentialed with the health plan. Certify will work to submit any individual provider applications, if applicable, and will ensure the plan provider's CAQH profile is updated and attested to.
Can you share reimbursement rates in advance of submitting enrollments and guarantee acceptance into health plans?
Every health plan has varying rates based on the market, specialty, and other factors. Additionally, the rates that health plans offer can change over time, and are not shared with clinics in advance of contracts being shared. As a result, we cannot share reimbursement rates in advance with our customers. Certify also cannot guarantee acceptance into the network, as some plans may close their panels if their networks are filled with the requisite volume of specialists in a particular geography.
Vetting a medical service provider requires more than a background check. Along with exhausting administrative tasks, paperwork, and manual record keeping, a healthcare organization needs to make sure the medical personnel they approve are credible and can be trusted with their patient’s health and care.
When someone is ill, all they really need is a fast diagnosis, the right prescription or treatment, and a speedy recovery. Time is of the essence, and dealing with an illness is stressful enough without added complications.
Telemedicine and virtual care models are scaling fast—and so are the regulatory frameworks that govern how they operate. As a leader in digital health, you’ve likely found that evolving licensing and enrollment requirements are standing between your organization and its full potential for growth.
