2023 Final Rule for Marketplace

2023 Final Rule for Marketplace

The Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2023 Final Rule for Marketplace health plans has a Network Adequacy provision regarding telehealth services. As of January 2023, HHS requires health plans to identify and...

read more

What Is Provider Enrollment

Provider enrollment refers to the process of becoming a participating provider in a health insurance plan or network. This process is typically required for healthcare providers, such as doctors, nurses, and other medical professionals, who wish to provide care to...

read more
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...

read more

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...

read more
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....

read more
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...

read more

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....

read more