CMS Revalidations Restarted

CMS Revalidations Restarted

In October, CMS began activities that were halted due to the public health crisis including: Application FeesCriminal background checks associated with fingerprint-based criminal background checksProvider/Supplier Revalidation Providers and suppliers that are required...

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UHC Out-of-network provider enrollment

UnitedHealthcare has introduced a new online portal allowing out-of-network providers to electronically register their taxpayer ID numbers  and practice demographics. Prior to submitting claims to UnitedHealthcare as an out-of-network provider, the following...

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Payer Credentialing and Telehealth (Part 2)

Payer Credentialing and Telehealth (Part 2)

It is a New Normal Commercial payers have been forced to accept telehealth services as an effective method of healthcare. Prior to the public health crisis, it was often difficult to obtain a participating provider contract from payer networks for telehealth services....

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Credentialing During the Pandemic

Credentialing During the Pandemic

It’s hard to believe that we have been battling COVID-19 for more than a year now. It has impacted every facet of our lives, but the hardest impact of this pandemic is the medical profession. Those who work in the medical field had to comprehend how to overcome new...

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ND Medicaid Approved to Expand Behavioral Health Services

The North Dakota Department of Human Services announced it has received final approval of the Medicaid 1915(i) State Plan Amendment from the Centers for Medicare and Medicaid Services (CMS), creating opportunities to expand community-based behavioral health services....

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Michigan Medicaid Requires Prescribing Providers To Enroll

Michigan Medicaid Requires Prescribing Providers To Enroll

Michigan health providers must enroll by Oct. 1 Beginning October 1, 2019, Medicaid beneficiaries with prescriptions written by healthcare providers who are not enrolled with the Medicaid program will not be able to have the prescription filled. Federal requirements...

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CMS Address Edits May Cause Claim Denials

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)...

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