Ensuring Compliance and Accuracy with Medical Credentialing Services in New York
We take care of the entire credentialing process for New York healthcare practices — from initial provider enrollment to ongoing revalidations. Our team is made up of credentialing professionals with 5 to 15 years of experience, ensuring that your account is handled by experts, not entry-level staff.
What Sets Us Apart
Why Our Credentialing Services Excel for New York Practices
Credentialing is key for staying in-network with New York’s payors. At TMS Billings, we simplify the process to ensure compliance and prevent delays. Here’s what makes us different:
- New York Credentialing Expertise In-depth understanding of New York’s Medicaid, Medicare, and VBC requirements ensures timely approvals.
- Fast Primary Source Verification All document gathering, background checks, and provider verification are handled to meet New York’s standards.
- Fast In-Network Approvals Expedited credentialing with New York payors to get your practice in-network quickly.
- Ongoing Maintenance Tracking credential expiration and re-credentialing deadlines keeps your practice compliant without interruptions.
- Managing New York-Specific Nuances Special handling of New York Medicaid Managed Care, HARP, and MLTC plan requirements for full compliance.
Payer Enrollment & Group Contracting
Getting your practice in-network is essential for smooth operations. We handle the paperwork to get your providers enrolled with Medicaid, Medicare, and commercial plans in New York, ensuring quicker and correct payments.
Handle Enrollment
We manage all the paperwork.
Focus on the Right Plans
We ensure enrollment with the right payers.
Get In-Network Faster
We speed up the process.
CAQH Profile Setup & Maintenance Maintenance
A well-maintained CAQH profile is key to avoiding billing delays. We set up and manage your profile, ensuring it’s always correct and up-to-date for smooth credentialing.
- Easy Setup We handle profile creation.
- Stay Up-to-Date We update your profile as needed.
- Avoid Billing Delays A complete profile means fewer claim issues.
Medicare & Medicaid Revalidations
Missing revalidation deadlines can disrupt your payments. We track and submit all revalidation paperwork on time to keep your practice in good standing with New York payers.
- Timely Submissions We manage all paperwork.
- No Gaps in Coverage Revalidations done correctly.
- Stay Compliant We ensure full compliance and avoid penalties.
Hospital Privileging & Staffing Support
We manage the credentialing process for hospital privileges, ensuring your providers can start seeing patients without delays.
Handle Credentialing
We manage all paperwork.
Meet Facility Requirements
We ensure compliance with hospital standards.
Stay On-Track
We ensure timely submissions for smooth transitions.
License, DEA & Board Certification Tracking
We track all licenses, DEA registrations, and board certifications to ensure your providers are always compliant and avoid service interruptions.
- Automatic Reminders Timely alerts for renewals.
- No Expiration Issues We prevent lapses in credentials.
- Full Compliance Stay compliant with both state and federal regulations.
Managed Care Contract Negotiation
Negotiating contracts can be tricky, but we handle the process to ensure your practice gets the best reimbursement rates from New York Medicaid, Medicare, and commercial payers.
- Focus on Reimbursement Rates We secure the best rates.
- Understand the Fine Print We review every detail for you.
- Save Time We manage the entire negotiation process.
Benefits
Tackle Credentialing Delays and Boost
Your Practice’s Cash Flow
Incomplete, inaccurate, or outdated application data affects nearly 85% of credentialing submissions. At TMS Billings, we ensure your credentialing is accurate, complete, and fast, avoiding costly delays and administrative bottlenecks.
Accelerated Credentialing Approval
We know the ins and outs of the medical credentialing process for New York practices, making sure all required paperwork is accurate and submitted on time.
Compliance With Regulatory Standards
Our expertise in New York’s specific payer regulations ensures that your practice stays compliant with state and federal requirements. We manage the paperwork and follow-up, reducing the risk of audits and penalties.
Enhanced Patient Safety
By verifying education, training, and licenses, we help maintain the highest standards of patient care and safety, all while offering the best credentialing service for New York providers.
Strengthened Provider Networks
Our team facilitates access to the right networks, so your practice can work with top-tier insurance plans. We handle the process for joining PPOs and health plan networks to expand your practice’s reach.
Operational Efficiency
Outsourcing credentialing to TMS Billings saves your valuable time. With our experience, your administrative staff can focus on patient care while we take care of documentation.
Credentialing Process Designed for New York Practices
Efficient, thorough, and designed to meet the specific demands of New York’s healthcare regulations and payor systems.
Initial Assessment
Evaluate credentialing needs for New York payors, including Medicaid, HARP, and MLTC, ensuring compliance with state regulations.
Document Collection
Gather required documents and verify compliance with New York’s strict credentialing standards for Medicaid Managed Care and other payors.
Primary Source Verification (PSV)
Confirm credentials, background checks, malpractice claims, and references according to New York’s regulatory requirements.
Submission & Follow-up
Submit credentialing applications and follow up with insurers to ensure timely approvals, particularly with New York-specific payors like MLTC and HARP.
Ongoing Maintenance
Track credential renewals to maintain in-network status and stay compliant with Medicaid, Medicare, and VBC guidelines.
Let's Know Your Interest
Frequently Asked Questions
Do you have questions about our medical billing and coding company? Let’s help you out.
Do you only work with New York practices?
New York is the core focus. We also support surrounding states when a group has locations that cross state lines, for example New Jersey and Connecticut. The approach stays the same. Regional payor rules, portals, and workflows, not generic billing.
Do you handle New York Medicaid, both fee for service and managed care?
Yes. We handle New York Medicaid fee for service workflows tied to eMedNY, plus Medicaid managed care plan billing. That includes eligibility checks, claim status follow up, denials, resubmissions, and appeals.
What is eMedNY, and why does it matter?
eMedNY is New York’s Medicaid system for provider billing operations, reference material, and tools like claim status inquiry. If a billing team does not know how to work eMedNY correctly, you usually see it in slow claim fixes and aging A R.
We already have a workflow. What changes when we switch?
We merge into your existing workflow. If you want, we take specific steps off your staff’s plate while you keep control of the rest. If you want a full transition, we take the workflow over from the prior billers and keep it moving with minimal disruption.
Will you work inside our current EMR, PM, and clearinghouse?
Yes. Most practices want continuity. We work in your existing system and document the workflow so your team knows what is happening and where to look.
If you do not have a platform, or your current platform is controlled by a billing vendor and you cannot keep it, TMS can provide a platform so you are not boxed in.
If your practice prefers paper and superbills, we can run the workflow that way too.
Stay Up-to-Date with Our Billing Insights
- Billing, Guides
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- Guides
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- Guides
Submitting accurate claims is just one part of medical billing, but understanding the documents sent by the insurance company
Fix Credentialing Errors and Accelerate Your Billing
Get your credentialing in sync with New York’s Medicaid, Medicare, and commercial payor rules.
