Credentialing is a complex process that requires a lot of documentation and verification to become part of an insurance network. A simple error or missing form can delay enrollment and result in a significant loss of revenue by making that network’s patients inaccessible to you.
Medcare MSO stands out as the premier provider of medical credentialing services in the US. We simplify the process so that you can focus on your core mission. Our experts handle credentialing tasks efficiently, from primary source verification to premium network enrollment.
We assist healthcare providers to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. Understanding the insurance credentialing process is crucial, as it involves adhering to specific requirements and overcoming potential challenges such as thorough research and proper communication with insurers.This leads to a wider patient base and, potentially, a lot more revenue for their practices.
Our healthcare credentialing services help individual providers (Type 1) and organizations (Type 2) obtain or update their National Provider Identifier (NPI). This makes it easier for them to send HIPAA-compliant bills and claims electronically.
We help healthcare providers get hospital privileges, which allow them to admit and treat patients at affiliated hospitals. As a result, they can work with other healthcare professionals and expand their scope of practice.
Negotiation is required with each insurance payer to get the most favorable terms and maximum reimbursement rates. Our experienced credentialing team helps physicians negotiate contracts with insurers to get the most favorable terms for their services, payment rates, and network inclusion.
Most insurance plans have a backlog of credentialing applications. Medcare MSO makes sure that your application gets received. We check regularly to see where it is in the process. Our dedicated team maintains a record of all ongoing follow-ups until the application is approved and participation is confirmed.
Application errors may result in delays and denials. Our diligent team ensures your application is complete and gets approved the first time it is submitted. We carefully submit your practice address, license, fax, contact information, services provided, and any other records of experience to prevent delays or denials.
Our physician credentialing services comply with the National Committee for Quality Assurance (NCQA) standards. This provides our clients access to preferred partnerships and networks, ultimately expanding your patient base.
We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements
We will verify your credentials with the issuing bodies. Our expert team will double-check everything with the official sources. Once everything is in order, we will assist you in obtaining approval from hospitals and insurance companies.
Contact Medcare MSO to discuss the details of your organization and health plans for enrollment.
Our team will complete the appropriate applications and submit them to your preferred payers
Contact Medcare MSO to discuss the details of your organization and health plans for enrollment.
We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements.
Our team will complete the appropriate applications and submit them to your preferred payers.
The necessary documents vary depending on the insurance plan and the type of physician/practitioner. The following is a list of some fundamental documents that are typically needed:
Personal documents:
Additional required documents:
Documents required for your legal entity:
While credentialing is a necessary process there are common mistakes healthcare providers can make that can cause delays, denials or even loss of revenue. Here are some:
Incomplete or Incorrect Application: Make sure all applications are complete and accurate. Missing or incorrect information causes delays or denials.
Not Meeting Deadlines or Following Up with Insurers: Timely submission and regular follow-up is key. Missing deadlines or not following up causes big delays.
Not Verifying Provider Credentials or Qualifications: Always verify provider credentials and qualifications before submitting. This step is critical to avoid rejections.
Not Keeping Provider Information Up to Date: Keep all provider information current. Outdated information causes problems during re-credentialing.
Not Fixing Credentialing Issues Quickly: Monitor credentialing applications regularly and fix issues as they come up to avoid delays.
By doing this healthcare providers can have a seamless credentialing process for their patients, practice and revenue.
Medicare enrollment for regular providers takes 2-3 months but allows retroactive billing. Note that this period can vary from state to state. For DMEPOS suppliers, expect a longer wait due to stricter confirmation, including a site visit.
CP575 is an IRS notice that confirms your business’s Employer Identification Number (EIN). It’s basically a confirmation letter saying your business tax ID application was successful.
This letter serves as additional verification of the business’s legal name and must be submitted with the Medicare enrollment application. If the original is unavailable, a replacement letter (147C) can be requested as proof of the EIN. Medicare accepts only these two documents as proof of the EIN.
The specific Medicare application used for provider enrollment depends on the type of provider enrolling. Here’s a breakdown:
You can find these forms and more information on the official CMS website:
In most cases, yes, providers must have a service location to begin credentialing for Medicare. Providers cannot use their home address as a clinic address, either permanently or temporarily.
While some exceptions might exist, a home address can be used for billing and correspondence, as long as a physical business address is also provided. This works even if the office is still under construction. The application can be submitted up to 30 days before the location opens for patients. Most commercial carriers have the same policies.
Are you ready to experience a streamlined and efficient credentialing process? Partner with Medcare MSO and let our expert team provide you with smooth and efficient physician credentialing services.
We guarantee to accelerate the credentialing process, submit clean claims, and maximize your revenue potential by up to 30%.
A member of our team will get in touch with you in 12 hours.
800-640-6409
