Ins Credentialing & Contracting

The process involves a thorough review and verification of several critical areas, ensuring compliance with state and federal regulations, as well as standards set by organizations like NCQA and The Joint Commission.

  • Licensure Verification: Confirming active and unrestricted medical, professional, or specialty licenses.

  • Education & Training: Verifying diplomas, residency, fellowship, and specific training records.

  • Board Certification: Confirming current status with relevant certifying boards.

  • Malpractice History: Reviewing professional liability claims history.

  • Background Checks: Ensuring a clean record concerning sanctions or exclusions.

Credentialing is the foundational process by which we verify that every provider within our practice meets rigorous professional standards. It’s our formal promise to our patients and partners that our care is safe, ethical, and delivered by fully qualified professionals.

All of our processes follow strict HIPAA guidelines to safeguard patient data and maintain complete confidentiality.

HIPAA Compliance

PHI Security

We implement advanced data protection measures to ensure the highest level of security for Protected Health Information (PHI).

Quality & Accuracy

Our team follows standardized protocols with regular audits to deliver accurate, error-free documentation and billing support.

Why Partner with us?

In the complex world of healthcare administration, efficiency, compliance, and strong relationships are key. When you choose Mediora Solutions LLC for credentialing and contracting, you are choosing a partner dedicated to streamlining processes and ensuring long-term success.

1. Exceptional Compliance & Integrity:

We maintain meticulous records and adhere strictly to all regulatory standards (e.g., NCQA, URAC). Our commitment to compliance minimizes risk and administrative burden for your organization.

2. Rapid Network Integration:

Our contracting team is highly organized and focused on efficiency. We aim for swift turnaround times on contract negotiations and credentialing submissions, ensuring our providers can begin serving your members faster.

3. Dedicated Point of Contact:

You won't get lost in automated systems. You will have a specific contact within our Payor Relations Department for seamless communication regarding rates, contracts, and utilization management.

4. Quality Focused Care Delivery:

Our practice is built on a foundation of high clinical standards. By partnering with us, you expand your network with a reliable provider group known for delivering excellent, patient-centered care, leading to higher member satisfaction.

5. Streamlined Onboarding Process:

We have a dedicated, experienced credentialing team that manages your entire application process with payers (e.g., CAQH profile management, follow-ups, and submissions). We eliminate the administrative headaches for you.

6. Maximized Network Coverage:

We proactively pursue contracting with all relevant major and specialty payers in our region. This ensures you are credentialed quickly across a comprehensive range of networks, optimizing your patient volume and reimbursement potential.

7. Continuous Monitoring & Maintenance:

Credentialing is an ongoing responsibility. We take ownership of re-credentialing cycles, license renewals, and updating payer files, ensuring your ability to bill is never interrupted.

The Specialties we serve

Our Virtual experts are experienced across multiple Specialties to ensuring processing with highly accuracy whether its billing or other task virtual Scribe and Authorization no matter which specialty your practice relies on.

Dermatology

Cardiology

Behavioral Health

Internal Medicine

General Surgery

Gastro Enterology

Orthopadic

Pain Management

Physical Therapy

psychiatry

Rehabilitative Medicine

Neurology

No matter your specialty, our virtual healthcare solutions adapt to your unique practice needs.

Provider Credentialing: Our Commitment to Quality

Contracting is the formal agreement between Providers and insurance carriers (payers) that allows you to provide in-network services to their members. Our goal is to partner you with as many major networks as possible to minimize out-of-pocket costs for your patients.

We are proud to be enrolled you with a wide range of national and regional insurance plans.

1. Commercial PPO / HMO Plans

  • Aetna (All Commercial Plans)

  • Blue Cross Blue Shield (All State/Regional PPO and HMO plans)

  • Cigna

  • United Healthcare / Optum

  • Humana

  • All other Regional Commercial Insurance Plans

2. Government & State Plans

  • Medicare (Part B only)

  • Medicaid (State-specific plans: e.g., Amerigroup, Molina)

  • Tricare (All Regions)

  • CHAMPVA

3. Specialty & Other Networks

  • Workers' Compensation (Specific state carriers)

  • MultiPlan / PHCS

  • EAP (Employee Assistance Programs)

Our Client's Reviews

Discover how healthcare providers across the U.S. are transforming their practices with our Virtual Medical Assistant services. From smoother operations to happier patients, our clients share the real results they’ve achieved with our support.

I was initially hesitant about outsourcing, but the transition was seamless. My VMA integrated perfectly into my EHR system and reduced my administrative burden by at least 60%. It feels like having an in-office team member without the overhead costs.

Dr. James Carter

Chiropractor, Florida

Hiring a Virtual Medical Assistant through this company has been a game-changer for my clinic. They handle scheduling, insurance verification, and billing with precision, allowing me to focus entirely on patient care. My staff and patients are happier than ever!

Dr. Sarah Mitchell
Family Practice, Texas
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My Virtual Medical Assistant is efficient, professional, and always reliable. From managing patient calls to handling documentation, everything is done accurately and on time. I can’t imagine running my practice without this support.

The support we receive is outstanding. Claim denials have dropped, reimbursements are faster, and patients appreciate the smooth scheduling process. The cost savings compared to hiring in-house staff are incredible.

Behavioral Health, CA
Dr. Kevin Patel
Dr. Linda Rodriguez
Practice Manager, NY