Credentialing

Guidant MSO handles the entire process of initial credentialing by collecting and verifying provider information such as education, licenses, certifications, and work history, and by submitting complete applications to insurance payers to ensure providers can participate in various networks.

We assist providers in creating and maintaining their CAQH (Council for Affordable Quality Healthcare) profile, ensuring that all information is complete, accurate, and regularly updated. This helps streamline the credentialing process with insurance payers that rely on CAQH for provider enrollment and verification.

We manage the re-credentialing process, which typically occurs every two to three years, by tracking credential expiration dates, collecting and verifying updated provider information, and submitting the necessary documentation to health plans. This ensures providers maintain active status, avoid lapses in participation, and remain eligible for reimbursement.

Guidant MSO manages the complex payer enrollment process by preparing and submitting applications to Medicare, Medicaid, and commercial insurers. We also track and monitor the progress of each application, communicate with payers as needed, and address any issues to ensure timely approvals and active network participation for providers.

Guidant MSO performs thorough primary source verification by directly contacting licensing boards, educational institutions, and certifying bodies to confirm a provider’s credentials. This includes verification of licensure, education, board certifications, malpractice history, and current DEA registration to ensure full compliance with regulatory and payer requirements.

We prepare providers and organizations for audits by maintaining thorough, up-to-date, and compliant credentialing records. This ensures full readiness for reviews conducted by payers, accrediting organizations, or regulatory agencies, helping to minimize risk and avoid potential disruptions in network participation.