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...

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Payer Enrollment – The 1st Step In The Revenue Cycle

Payer enrollment services help healthcare organizations to unravel the complex process of credentialing providers and enrolling them in payer networks. Payer enrollment is the process of a provider joining a health insurance plan’s network. The process includes...

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New To Private Practice and Insurance Billing?

Private Practice and Insurance Credentialing Healthcare providers venturing out into private practice often are unsure about how to establish their procedures for billing third party networks for services.  The process of billing and reimbursement is referred to as...

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How long does credentialing take

Insurance Credentialing Timeline The most often asked question when speaking with a healthcare provider about insurance credentialing is, “How long does it take to get credentialed?”.  This is a difficult question to answer because the turn around times of carriers...

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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 submission...

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Tricare Merges Regions for 2018

Tricare Provider Enrollment There are some changes to the Tricare program effective January 1, 2018 that affect the provider enrollment process.  The new "East Region" merges the current north and south regions to make a new singular region.  The U.S. Department of...

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Michigan Medicaid Enrollment

Effective Jan. 1, 2018, all providers who serve Michigan Medicaid beneficiaries, including providers participating in a Managed Care Organization’s (MCO) provider network, are required to be screened and enrolled in the Michigan Medicaid program. The purpose of this...

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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). FQHC Services...

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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...

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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...

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CMS Improves Functionality With NPPES Updates

Updates to NPPES CMS has launched an updated version of the National Plan and Provider Enumeration System (NPPES).  The new unified login for NPPES makes it easier for users to manage type 1 and type 2 NPI records, increases security, provides new surrogacy...

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