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The Payer Provider Enrollment Process

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)...

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Corporate Practice of Medicine in California

The state of California has specific guidelines for medical practice organizations forming business entities. Essentially the state requires medical corporations to be formed as a Professional Corporation (PC), the make-up of the corporation a must be at least 51%...

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New CMS Specialty Code for Hospitalists

When they enroll in the Medicare program, physicians self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855I or CMS-855O), or in the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). CMS uses these...

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nCred Client Portal

Another nCred Advantage nCred is excited to launch a new client portal that will improve the ease of access to credentialing information for healthcare organizations to better oversee the credentialing process for its providers.   The new nCred client portal is...

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CT Medicaid Enhanced Provider Enrollment Screening

Fingerprint Based Criminal Background Checks Effective October 13, 2016 the Connecticut Medicaid program will begin requiring fingerprint based criminal background checks (FCBC) for all providers designated as a "high" categorical risk.  The new screening measures...

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MassHealth (MA Medicaid) Plan Changes

MassHealth Ordering, Referring, and Prescribing Policy There are some significant changes taking effective September 1, 2016 with the Massachusetts Medicaid program (MassHealth).  Every provider licensed in the state must now have an active enrollment record with...

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Credentialing After Relocation – What Is Needed?

Insurance Credentialing After You Relocate We routinely hear from healthcare providers who have relocated to another state or are planning a relocation, and need assistance with getting in-network with insurance panels in their new practice state.  Many are frustrated...

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Medi-Cal provider enrollment going electronic

Medi-Cal’s Doctor Sign-Up System Finally Going Online Medi-Cal’s enrollment system for doctors and other health care providers, long criticized in the medical community for being complicated and slow, is getting an overdue transformation. Paper is out, computers are...

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New Physician Credentialing – Timing is Everything

It is always a good sign when your practice recruits a new physician fresh from medical school. It brings attention to your practice, and can help you build a reputation of being a forward-thinking practice that offers the newest and best patient care practices. ...

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Provider Enrollment Requirements for Medicare Part D

Deadline for enforcement of provider enrollment requirements for prescribing Medicare Part D drugs has changed In 2014 CMS announced that all provider's who write prescriptions for Part D drugs must have an approved Medicare enrollment record or a valid Opt-Out...

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Common Payor Enrollment Mistakes

Whether you are starting a new solo practice or adding a new physician to an existing large medical group, an efficient process for credentialing and contracting with insurance networks is key to minimizing financial loss when you begin seeing patients.  The process...

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