Cred Hawk
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Provider Credentialing Services
Trusted Services for Provider Credentialing
Medical billing is not the only task that disrupts healthcare providers’ revenue cycle management. Provider credentialing is equally important and takes up considerable time and resources. On top of that, when a healthcare provider fails to get credentialed, receiving reimbursement becomes challenging. That’s why AlterMed RCM is here to solve your hassle related to credentialing and help you stay profitable. Our services help you navigate through the critical credentialing process and prove that you are qualified, compliant, and trustworthy.
We know that provider credentialing is the foundation of ensuring smooth operations, compliance, and timely compensation. With our services, you will streamline your provider enrollment and credentialing process without any hassle.
Choose AlterMed RCM and experience professional credentialing, faster enrollment, and compliance assurance along with proper tracking and reporting. Get personalized services for your specific requirements.
Seamless Credentialing Process
- Collection, verification & accuracy check on all necessary provider documents
- Timely submission & active tracking of application to follow up on progress
- Credentialing approval & enrollment along with maintenance for expirations, renewals & more
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Expert Credentialing Specialists
Our team holds the necessary expertise to handle all aspects of credentialing, including maintaining a network with all major payers.
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Smooth & Systematic Process
We work on reducing your administrative burden, minimizing credentialing delays, and increasing revenue capture with timely enrollment.
At AlterMed RCM, our team is proficient at understanding your requirements and helping you get credentialed quickly and correctly. From document collection to payer submission, we manage the entire process. Our accurate and efficient services are designed to reduce errors, track deadlines, and get faster credentialing approvals. We also ensure compliance with payer regulations implemented by insurance companies, Medicare, Medicaid, and hospitals.
Simplified Lengthy & Intricate Approval Process
A normal credentialing cycle lasts for 60 to 180+ days, and every insurer has different rules and forms. Our team is well-versed at handling this lengthy and intricate process with perfection.
Shift the Administrative Burden to Professionals
Our team of certified credentialing specialists takes over your entire operational workload and frees you from stress. We also do real-time tracking, so you always know the status of your provider applications.
Stay Compliant and Prevent Revenue Loss
We monitor license expirations, certifications, and re-credentialing deadlines to ensure regulatory compliance across all payers and networks. This prevents revenue losses and enhances the profitability of your practice.
Provider Enrollment & Credentialing
Get Verified, Enrolled and Listed with AlterMed RCM
Provider credentialing and enrollment are essential to get legally and financially recognized by insurance providers. At AlterMed RCM, we help you with crucial administrative steps:
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Initial Provider Enrollment with Commercial and Government Payers
This is the first step of becoming an ‘in-network’ provider. Whether you are enrolling with commercial payers or government payers, we help you:
- Submit Applications to Each Payer
- Provide Licenses, Certifications and More to Payers
- Get Provider ID with Each Payer
- Establish Billing Rights Under Your Name or Organization
This registration step is crucial for healthcare providers to bill insurance and get revenue.
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Medicare, Medicaid, and TRICARE Enrollment
We help healthcare providers who want official approval to treat patients under government with:
- Completing CMS Enrollment Forms (e.g., CMS-855 series for Medicare)
- Meeting Strict Compliance and Eligibility Rules
- State-specific Medicaid Enrollment Processes
- Linking Providers to Specific Practice Locations
Government insurance programs have stricter rules and longer processing time compared to commercial insurance programs.
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CAQH Profile Creation, Attestation, and Ongoing Maintenance
CAQH (Council for Affordable Quality Healthcare) is a vital credentialing database used by most commercial insurance providers. We help you:
- Create a Provider Profile
- Upload Supporting Documents
- Attest Proof of Credibility (confirming accuracy every 120 days)
- Update Credentialing Information Regularly
Once healthcare providers create CAQH profiles, they don't need to submit documents repeatedly.
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PECOS Enrollment and Revalidation Management
PECOS (Provider Enrollment, Chain and Ownership System) is the Medicare enrollment system used by CMS. We help you with:
- Online Medicare Enrollment Application Submission
- Linking Providers and Practices to Medicare Billing Privileges
- Managing Updates like Address, Ownership, or Practice Changes
- Handling Revalidation (typically every 3–5 years)
Maintaining PECOS is crucial — otherwise Medicare billing privileges can be suspended or revoked.
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New Group Setup and TIN Enrollment with Payers
Healthcare practices and clinics must establish themselves as legal billing entities. Our team helps practices and clinics enroll for TIN (Tax Identification Number). Our services include:
- Registering the Group Practice with Payers
- Adding the TIN to Payer Systems
- Linking Multiple Providers Under One Group Contract
- Setting Up Reimbursement Structures (group vs individual billing)
TIN enrollment is essential for providers to get revenue under a clinic, hospital, or group instead of individually.
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Individual and Group Credentialing Applications
This is the verification process of provider qualifications. Individual credentialing is for single providers, and group credentialing is for facilities and practice entities. We help you with:
- Education, Residency and Board Certifications Verification
- Licenses, Malpractice History, Sanctions and Exclusions Review
- Primary Source Verification (direct confirmation with institutions)
- Credentialing Committee Review by Payers
Credentialing acts as proof that healthcare providers and practices are qualified to treat patients.
Maintenance & Recredentialing
Seamless Recredentialing and Maintenance
At AlterMed RCM, our services do not end at credentialing. We give necessary importance to recredentialing and maintenance so that healthcare professionals continue to be legally authorized. Partner with us and get:
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Ongoing Recredentialing with Payers
Continue to stay credentialed within insurance networks and prevent claim rejections or revenue loss with our recredentialing services that include:
- Tracking Payer Deadlines
- Submitting Documents
- Communicating with Insurance Companies
- Monitoring Approval Status
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CAQH Re-attestation and Profile Updates
Get CAQH re-attestation and profile updates every 120 days to prevent enrollment rejection and claim reimbursement delays with our services:
- Monitoring Attestation Deadlines
- Update Profiles
- Upload Documents
- Ensure Payer Access Permissions Remain Active
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Expiration Tracking Across Licenses, DEA, Malpractice, and Certifications
Track expiration of different credentials and meet different renewal cycles without missing expirations with proper tracking systems that provider:
- Automated Alerts
- Dashboards
- Renewal Workflows
- Escalation Notifications
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Payer Roster Updates and Maintenance
Keep up with payer roster updates and maintenance needs to avoid claims denials, compliance penalties and delayed reimbursements with services:
- Provider Data Accuracy Maintenance
- Roster Changes Submission to Payers
- Updates Coordination with Insurance Networks
- Acceptance Confirmations Monitoring
Credentialing Issue Resolution
Fast & Accurate Credentialing Issue Resolution
AlterMed RCM handles the errors, missing data and payer issues to solve credentialing hurdles effortlessly. Our credentialing issue resolution services include:
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Analyzing the Reasons
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Fixing the Problem
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Re-submitting Application
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Taking Follow-up from Payers
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Preventing Future Hindrances
With our fast and accurate credentialing issue resolution process, we manage to:
Prevent Revenue Loss
Speed Up Provider Onboarding
Improve Compliance
Reduce Administrative Strain
Provider Offboarding & Changes
Smooth Provider Offboarding and Demographic Updates
AlterMed RCM manages provider changes, terminations and updates with utmost accuracy and compliance. We take every measure to streamline the process of provider offboarding while also taking care of demographic updates and data modifications
Provider Termination with Payers
Simplifying the process of formally removing providers from insurance payer networks.
Demographic Updates (Address, Group, Tax ID Changes)
Updating payer records with new information, submitting change forms and ensuring CAQH updates
Adding and Removing Providers from Group Contracts
Submitting applications to include new providers under group contracts and ensuring payer approvals.
EFT/ERA Enrollment Updates
Enrolling providers in EFT systems and maintaining ERA delivery setup for billing teams.
Compliance & Audit Support
Complete Compliance and Audit Support
AlterMed RCM is your trustworthy compliance partner with services that help healthcare providers stay compliant without any trouble. We have all necessary certifications, including SOC 2 Type 1, ISO 27001, and HIPAA. Our team offers compliance expertise to improve your data security and audit readiness.
HIPAA Compliant
SOC 2 Type 1 Certified
ISO 27001 Certified
We follow a structured compliance framework to strengthen data security and establish better operational integrity. Our compliance and audit support is proactive and prevents healthcare professionals from increasing credentialing risks.
Increased Regulatory Security
Reduced Credentialing Risk
Enhanced Audit Preparedness
Higher Documentation Accuracy
Regular Compliance Monitoring
Partner with AlterMed RCM and get professional support at every step of credentialing!
How It Works
Provider Credentialing Workflow
Credentialing
Proves You are Qualified — verifies your education, licenses, certifications and professional history with payers.
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Enrollment
Registers You with Payers — formally enrolls you with commercial and government insurance payers to enable billing.
CAQH / PECOS
Centralized Systems that Store and Validate Your Data — single repository used by payers to verify provider information efficiently.
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Group / TIN Setup
Defines How Billing Is Structured — registers your practice as a legal billing entity so revenue flows under the correct group or clinic.
Ongoing Maintenance & Revalidation
Keeps Everything Active and Compliant — continuous tracking of renewals, re-attestations and revalidations so your credentials never lapse.
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Why choose us?
