Insurance Provider Credentialing

We help healthcare professionals and medical practices navigate the complex credentialing procedures necessary to participate in third-party payer networks, including Medicare, Medicaid, and private insurers (e.g., Aetna, Blue Cross/Blue Shield, US Healthcare, etc.). We also represent practitioners in connection with insurance company claims of overpayment and upcoding, as well as de-credentialing, re-enrollment, placement on the Preclusion List, and related proceedings and administrative actions.

Among recent matters, our lawyers have:

  • Brought about the successful reinstatement of physicians following the revocation of their credentials to participate in an insurance network
  • Negotiated multiple settlement agreements with various insurance providers regarding alleged overpayments to a practitioner
  • Successfully prosecuted an injunction requiring an insurance company to reinstate a provider and to reimburse well over $150,000 for claims previously denied
  • Represented physicians in disputes regarding payment with insurance providers

" I have referred numerous complex litigation cases to Dennis over the years, and my clients are always satisfied with his work ethic and professionalism. In addition, my clients report to me how impressed they are with his knowledge of the law, dedication, and communication. I strongly endorse him. " — Michael D.

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