Morrisville, North Carolina, USA 27560
We’ll work with you to ensure you have a variety of popular and effective in-network payers to work with. Our experienced team will determine timelines and open-panel availability with the payers of your choice.
We’ll work with you to gather all of the necessary information to file applications. We pride ourselves in our efficiency and thoroughness to ensure a short turnaround time and accurate filing.
Our team will ensure that the submitted application has been received by the payer and that there are no outstanding requests for changes. We follow up regularly with the payer until the contract comes through and arrives at your office or practice.
When needed, we will submit an extensive appeal when there are closed panels for labs of a particular specialty. We communicate your key points of services and overall history of exceptional patient care. We’re prepared for this challenge, as our team has a high success rate of overturned closed panel decisions.
If you as a provider choose to stay out-of-network with particular payers, or are forced to stay out-of-network due to closed panels, our team will handle out-of-network enrollments and NPI registrations on the payer’s website to prepare your practice to start receiving payments for these services.
We take care of any documentation required by demographic changes, such as a new Tax ID with your payers, updating addresses, changing bank accounts, and any other necessary tax. We’ll set up all ERA and EFT enrollments, as well.
Our credentialing portal manages all of your providers’ and physicians’ credentialing data, and is comprehensive, transparent, and HIPAA-compliant. to ensure we keep your database efficient and accurate.
We maintain and manage any PECOS and CAQH profiles that you may use, making sure all information is HIPAA-compliant and accurately profiled.
Credentialing builds trust with leading healthcare insurance companies.
Proper credentialing ensures accurate reimbursement for services rendered.
Credentialing ensures that providers fulfill requirements and follow rules, which reduces risk.
Timely credentialing helps to avoid financial losses due to delayed reimbursements / claims.
Private payers—90-120 business days
Government payers—120-180 business days
Facilities—120-160 business days
Up-to-date on all HIPPA compliance.
Risk Mitigation
Quality Assurance
Data Security
Trust and Confidence
Competitive Advantage
Custom Support and Communication
Customer signs, Rainbow Healthcare starts onboarding process
Call insurances to verify applications are still open : 3-5 days
Gather all relevant documents and information from customer
Rainbow Healthcare Services to submit all applications: within 2 weeks of a signed contract
Follow up with insurance providers & provide customer with biweekly updates
Application approved; contract & fee list ready for customer
Credentialing serves as a critical mechanism for guaranteeing that patients receive optimal healthcare services by confirming the qualifications and credentials of healthcare providers.
Credentialing is critical in enabling healthcare providers to adhere to regulatory requirements by ensuring that all providers meet the prescribed standards for delivering exceptional patient care.
By exhibiting a steadfast dedication to upholding standards of excellence and safety, credentialing can elevate the standing of healthcare providers, bolstering their reputation and engendering confidence and reliance among patients and the wider community.
Through the rigorous evaluation and verification of healthcare providers’ ability to meet the requisite standards of patient care, credentialing can bolster their fiscal performance by mitigating the likelihood of malpractice lawsuits and heightening patient contentment.
Credentialing plays a pivotal role in facilitating the formation of provider networks, as it entails meticulous validation of the qualifications and credentials of healthcare providers. This, in turn, fosters greater consistency in patient care and enables healthcare providers to furnish patients with more comprehensive and seamless services.
Credentialing Application Processing Time
Provider Enrollment Time
Submitted application to payer Accuracy Rate
Credentialing Application Accuracy Rate
Provider Data Accuracy Rate
Provider Satisfaction Score
Risk Mitigation
Physician Group Practices
Medical Laboratories
Skilled Nursing Facliities
Ambulatory Surgical Centers
Durable Medical Equipment
Pharmacy Billing
Tele-Radiology / Telehealth