Re-Credentialing – Preparation and Consequences
Re-Credentialing or revalidation is the dreaded date circled red on your calendar that might bring you a sleepless night or two. There are so many important components to re-credentialing which involve different due dates for commercial plans versus government plans,...
Medicare Provider Enrollment Program Integrity Enhancements
A new rule regarding Medicare provider enrollment allows CMS to revoke healthcare providers or suppliers’ Medicare enrollment if they are affiliated with targeted “bad actors”. As part of the CMS’ “Program Integrity Enhancements to the...
CMS Address Edits May Cause Claim Denials
The Centers for Medicare & Medicaid Services (CMS) recently announced implementation of validation edits in the Medicare enrollment system that may cause claim denials. These validation edits will apply to hospital outpatient prospective payment system (OPPS)...
Medicare Provider Enrollment – What is PECOS?
Medicare Provider Enrollment There are two ways to enroll with the Medicare program. First, complete the appropriate Medicare paper applications, or second, use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). This article focuses on provider...
Negative Impact of Medicare Administrative Contractor Changes in 2018
Medicare Administrative Contractor Changes in 2018 In 2018, the Medicare Administrative Contractors (MAC’s) for TN, GA, And AL changed from CAHABA to Palmetto. The change has had a dramatic impact on the turnaround time of Medicare provider enrollment...2018 Medicare Application Fee
CMS has announced the CY 2018 application fee for institutional providers enrolling with Medicare, Medicaid, or Children’s Health Insurance Program. The fee will be $569 representing a slight increase from 2017. This fee is required for all institutional...
FQHC Enrollment with Medicare
FQHC – Requirements and Enrollment Process Federally Qualified Health Centers (FQHC) are safety net providers that primarily provide services typically furnished in an outpatient clinic. FQHC’s are paid based on the FQHC Prospective Payment System (PPS)....
What is Insurance Credentialing
Insurance credentialing (or Provider Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting. The first...
What is Provider Enrollment
Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting. The first step...
