The document discusses the importance of timely physician credentialing in maintaining revenue flow for medical practices and avoiding claim denials. It offers strategies such as regular audits, maintaining updated profiles, and utilizing credentialing software or outsourced services to streamline the credentialing process. Ensuring active credentials is essential for physicians to bill payors effectively and avoid financial setbacks.

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Simple Tricks to Avoid
Credentialing-Related
Denials
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Introduction
• Keeping the Medical Practice revenue flow
intact and evergreen requires constant effort
from physicians and Medical practices.
• Overcoming financial lags owing to claim
denials and keeping up with the ongoing
changes and regular updates are prerequisites
for any practice to ensure the monthly
collections and claim reimbursements are
intact.
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• There are various reasons why a claim can
get denied and affect your cash flow, physician
credentialing is one among them.
• Timely Provider Credentialing and keeping
the credentialing privileges active are
mandatory to avoid related claim denials.
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Why is Physician
Credentialing Crucial?
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• Physician Credentialing is crucial as they
affect the financial aspect of the Medical
Practice or the Physician greatly if not valid.
• Without proper credentialing Physicians can
not send patient claims to the payor.
• Expired or invalid Physician Credentialing can
lead to claim denial and loss of
reimbursement.

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• Until the Medical Practitioners’ Credentialing
are complete and active the physician or
practice might not get their due payments from
the insurance carrier.
• Lack of proper Credentialing or Active
Credentialed status is equivalent to non-
participating or Out- of – Network providers.
• Therefore it is of paramount importance for the
Physicians to be in the network with active
credentials to ensure they are linked to all the
payors whom they would like to bill for.

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Tricks to Avoid Credentialing
Related Denials
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• Do a complete audit of your denials to analyze
if the lack of proper provider credentialing is a
reason. If yes, then take adequate steps to fix
them at once before it affects your bottom line.
• Keep a checklist of all the payors you are in-
network with or credentialed with and have a
streamlined approach to have them checked
and re-credentialed on time.

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• Set reminders to notify ahead on Re-
credentialing requirements so you have ample
time to get the required supporting document
for application and submission on time.
• Keep your CAQH profile up to date always
making any changes or updates as and when
required

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• Physicians getting first-time credentialed with
a payor should be well prepared with all
required documents to be submitted along
with the application for on-time processing and
enrollment.
• Incomplete and inadequate information or
documents can lead to unnecessary delays
and affect claims reimbursement

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• Investing and leveraging on credentialing
software can reduce human errors and delays.
Medical groups or practices needing frequent
credentialing support rely on these upgraded
technologies to pace up.
• Outsourcing to Credentialing Professionals of
Medical Billing Companies with an expert
team on Physician Credentialing is the most
lucrative method.

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Benefits of Outsourcing Provider
Credentialing
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• Access to top Physician Credentialing experts
• Effective and Efficient processing of each and
every credentialing application with utmost
care to ensure they are clean and clear on the
first submission to avoid unwanted delays and
hassles.
• Cost-effective and Stress- free

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• On-time Credentialing and Re-credentialing to
ensure your payments are intact and unaffected
avoiding claim denials due to lack of credentialing
requirements.
• Time advantage and Advanced Support yield more
scope for patient care
• Upgraded tools and technologies processing your
Credentialing application proficiently.
• CAQH updating and Re-credentialing reminders and
Support
• Reduces Claim denials due to lack of Provider
Credentials

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About MGSI
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• MGSI is a national Medical Billing and
Revenue Cycle Management Service provider
located in Tampa, FL.
• With over 27yrs in the Healthcare Industry
MGSI provides various scopes of services
right from End to end billing services and other
services like Physician Credentialing, Practice
Management, Healthcare Contracting, etc.

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• MGSI has expertise in handling credentialing
Services with different payers and our
Physician Credentialing team are experts in
handling each application adequately to meet
the elected insurance carrier’s requirements.
• To know more about MGSI and our services,
call 1-877-896-6474 or log on
to www.mgsionline.com

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Thank You