Medical Credentialing Services in Maine
Get Your Providers Credentialed Faster – Partner with Maine’s Trusted Credentialing Experts. We are the most trusted and professional platform, helping Maine practices streamline enrollment and improve reimbursements.
About Us–Trusted Credentialing Partner for Maine Providers
We are a Maine-based medical billing and credentialing company excelling in revenue cycle management services. We have 10+ years of experience in provider enrollment and RCM services custom-made for your specialty. Provider credentialing and contracting solutions we offer automates the entire process and ensures a certified and skilled credentialing team ensures every step is taken in a compliant way.
We assign seasoned enrollment staff which ensures providers possess and fulfill the required qualification and credentialing criteria, so they may get precise privileges to support their practice. With our efforts, healthcare providers may bid farewell to manual filing of documentations and laborious tasks pertaining to the enrollment process. Choose us as your premier partner in filing credentialing applications and get connected with desired insurance companies effortlessly.
Our Provider Credentialing Services
Initial Provider Credentialing
Credentialing experts of our company in Maine help MDs, DOs, NPs, PAs, LCSWs, and other providers get enrolled with their preferred network with ease. We offer assistance for insurance plans such as Medicare/Medicaid DMEPOS enrollment, commercial insurance credentialing, NPI registration (Type 1 & Type 2), creation and maintenance of CAQH profile, etc
Re-credentialing and Maintenance
With our medical insurance credentialing services, providers can easily manage the re-credentialing and revalidation of their enrollment profile with Medicare, Medicaid and other various commercial insurance companies. Credentialing managers of our company help you track recredentialing deadlines, resubmit CAQH and payer forms, update expired licenses, malpractice, CME, etc.
Payer Enrollment and Contracting
Beside usual credentialing and maintenance, we also assist healthcare professionals in getting enrolled with new insurance payers to maximize their revenue cycle. The credentialing team of our company negotiate with insurance companies on your behalf and help you secure more favorable terms and reimbursement rates to support your patient care activities.
Hospital Privileging Support
Our experts also enable physicians to use appropriate hospital privileges in treating chronic patients. We facilitate providers in treating and admitting patients at an affiliated hospital or IPD (in-patient department). This service expands the pool of patients being treated in out-patient and in-patient facilities.
Why Credentialing Matters in Maine?
- Without proper enrollment, providers cannot bill payers
- Maine’s payer systems are strict on deadlines and documentation
- Fast and compliant credentialing = uninterrupted revenue
- Efficiency and speed results in streamlined process with less chances of delays
- Outsourcing protects your revenue from claim denials
- Providers credentialing solutions minimize regulatory fines and penalties
- Outsourcing help providers and their to focus on core activities e.g,. patient care
- Our credentialing services integrates accuracy and compliance for better results
Industries & Providers We Serve Across Maine
We serve a variety of providers in getting enrollment with various payors in Maine like MaineCare, MaineHealth, Northern Light Health, Central Maine Healthcare, FQHCs in Maine, etc. Following are the practices we work with in Maine, including:
- Solo providers and private practices
- Behavioral health clinics
- Family medicine clinics
- Urgent care and specialty groups
- Telehealth providers
- Rural health clinics and FQHCs
Our Credentialing Process: Step-by-Step
Our insurance credentialing services entails the following process to help you get close to insurance payers:
Credentialing Applications
The first process of our doctor credentialing services is the initial gathering of provider’s information such as their academic background, specialty, history and ability to treat patients, etc
Primary Source Verification
After the submission of the provider’s application, health insurance companies verify the education and degrees, training received during residency, medical licenses and additional certifications, work history and current employment status, etc.
Insurance Plan Submissions
Providers may have to go through a selection process where they choose either in-network or out-of-network enrollment, whichever suits their practice. It’s an essential step to get enrolled in an insurance network.
Payer Follow-ups
After going through all the above mentioned steps, we follow the credentialing and enrolment process closely and keep you informed on various stages your application has been going through.
Real-time Updates
We offer real-time updates about the entire process including further requirements, such as site visits, credentialing committee review and any missing document that may be asked by health insurance companies.
Contract Finalization
After the formal approval of the credentialing and enrollment applications, healthcare providers may enter the negotiation phase including reimbursement rates, scope of services, out of network payments, etc. After this, providers just need to sign the contract, commencing a formal agreement and enrollment in the payer’s network.
Why Choose Us for Credentialing in Maine?
- Expert application completion
- Compliance with NCQA
- Continuous CAQH monitoring
- Reduced administrative burden
- Aggressive Follow-up
- Increased revenue
- Improved patient care
- Credentialing solutions for 50+ specialties
- 24/7 access to experts
- Time efficient
- Comprehensive end-to-end support
- Personalized attention to your needs
Credentialing Services for All Medical Specialties
We offer physician credentialing and enrollment services to more than 50 medical specialties including:
- Internal Medicine
- Psychology
- Urgent Care
- Pharmacy
- Oncology
- Psychiatry
- OB/GYN
- Cardiology
- Surgery
- Emergency Room
- Family Practice
- Pediatrics
- Orthopedics
- Dermatology
- DMEPOS
- Podiatry
- Licensed Therapists (LCSW, LPC)
- Behavioral Analysts (ABA Therapy)
Integrate Credentialing with Our Medical Billing Services
- Expert application completion
- Ensure faster revenue cycle post-credentialing
- Reduced errors, one-stop communication
- Unified billing + enrollment = fewer denials
Frequently Asked Questions (FAQs)
How long does credentialing take in Maine?
The credentialing procedure in Maine may take up to three months. However, delays can occur as a result of insufficient information or insurance company mergers. To avoid delays, gather all essential paperwork precisely and follow up with the insurance company on a frequent basis.
What are the credentialing requirements for MaineCare?
- Online Application: Providers must apply through the Health PAS Online Portal using the Provider Enrollment Application (PEA).
- Trading Partner Account: Required to access the Maine Integrated Health Management Solution (MIHMS).
- Screening Requirements: Based on categorical risk levels (limited, moderate, or high), as mandated by the Affordable Care Act (ACA).
- Supporting Documents: Providers must submit documentation such as:
National Provider Identifier (NPI)
Licensure and certifications
Taxonomy codes
Background checks (depending on risk level)
Can you credential providers in rural areas?
Yes absolutely, our credentialing services are suitable to all types of practices regardless of their geographic location. In fact, our credentialing staff is well-versed and helpful for rural practices. We help providers whether their practice is solo or a group located in rural areas or outside of it
What if we have a large provider group?
Whether you have group practice or a solo clinic, our services have the flexibility and capacity to serve all types of practices. We have been serving a variety of medical specialties, more than 50 specialties we have worked with and continuing to do so.
Let Us Improve and Grow Your Practice’s Revenue
Let us handle your credentialing while you focus on care. Serving all cities in Maine including Portland, Bangor, Augusta, Lewiston, and more.