Medicare & Medicaid Enrollment

TriumpHealth delivers comprehensive solutions for provider enrollment across all specialty types with Medicare and Medicaid

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PROVIDER CREDENTIALING & PAYER ENROLLMENT

Medicare and Medicaid Enrollment: Your Path to Success

Provider credentialing service is necessary to receive in-network reimbursement from payers. The ability to accept patient insurance plans is essential for the success of your practice. Procrastination and haphazard credentialing application processing can result in significant cash-flow challenges for your providers. Fortunately, there are ways to minimize issues with credentialing

How Does PECOS Online Enrollment Work?

PECOS is an enrollment management system that allows providers to:

Enroll as a Medicare provider or supplier
Review information currently on file
Upload your supporting documents
Electronically sign and submit your information online

Medicare and Medicaid require providers that apply online to have an account in PECOS. This account is how government payers access your provider information, and our team validates that your account is complete and up to date during your enrollment process.

If any of the below changes occur, the Payer should always be notified within 30 days:

Change in Executives (CEO, COO, CFO, EVP, etc.)
Change in Practice Location or Addition of New Location
Board of Directors Location Change
Adverse Legal Action against a Provider or the Organization

Increase Your Revenue By Enrolling In Medicare And Medicaid Today!

Medicare enrollment can be a complex and overwhelming process, but with TriumpHealth’s expert assistance, you can secure your future with ease. Our team handles the tedious paperwork and submission process, ensuring a hassle-free experience for you. With our help, you can enroll easily with Medicare and Medicaid and enjoy the peace of mind you need. Don’t wait any longer; let us help you take the first steps towards maximizing revenue today.

Frequently Asked Questions

What is the significance of Medicare and Medicaid enrollment for healthcare providers, and why is it essential for participation in government-sponsored healthcare programs?

Medicare and Medicaid enrollment are crucial for healthcare providers as they allow participation in government-sponsored healthcare programs, which serve millions of beneficiaries nationwide. Enrollment ensures that providers can deliver essential services to Medicare and Medicaid patients, receive reimbursement for covered services, and contribute to improving access to care for vulnerable populations.

How do you initiate and manage the Medicare and Medicaid enrollment process for healthcare providers, ensuring compliance with program requirements and regulations?

We initiate and manage the Medicare and Medicaid enrollment process by guiding providers through the application process, submitting required documentation, and liaising with Medicare Administrative Contractors (MACs) and state Medicaid agencies. Our team ensures compliance with program requirements and regulations by staying updated on enrollment guidelines, submitting accurate information, and following up on application progress.

Can you explain the typical timeline for Medicare and Medicaid enrollment, and what strategies are employed to expedite the process while maintaining accuracy?

The typical timeline for Medicare and Medicaid varies depending on factors such as application completeness, program workload, and processing times. To expedite the process while maintaining accuracy, we prioritize timely submission of applications, closely monitor application status, and provide necessary documentation promptly. Additionally, we leverage our expertise to navigate potential hurdles and streamline the enrollment process whenever possible. The average time a provider can expect for Medicare application approval is at least 45 business days from the date of application submission. Medicaid depends from state to state but typically is at least 90 days from the date of application submission.

What information and documentation are required from healthcare providers during the Medicare and Medicaid enrollment process, and how do you ensure the completeness and accuracy of these details for each program?

Information and documentation required for Medicare and Medicaid enrollment typically include provider credentials, practice location information, tax identification numbers, and compliance certifications. We ensure the completeness and accuracy of these details by conducting thorough reviews of application materials, verifying documentation against program requirements, and communicating closely with providers to address any discrepancies.

How do you stay updated on changes in Medicare and Medicaid requirements and policies, and how does this information impact your approach to enrollment services?

We stay updated on changes in Medicare and Medicaid requirements and policies through continuous education, participation in industry conferences, and regular communication with program administrators. This information informs our approach to enrollment services by enabling us to adapt quickly to regulatory changes, anticipate program updates, and provide informed guidance to healthcare providers throughout the enrollment process.

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Our Process

Application Submission

We initiate the process by submitting credentialing applications to the Centers for Medicare & Medicaid Services (CMS) or the respective state Medicaid agency, depending on the program. These applications entail provider information, education, training, licensure, certification, and practice history, tailored to meet the specific requirements of Medicare and Medicaid.

Verification and Review

The credentialing entity, such as CMS or the state Medicaid agency, conducts thorough verification and review of the information provided in the credentialing applications. This process involves verifying provider credentials, including licenses, certifications, education, training, work history, malpractice history, and professional references. Primary source verification is often employed to ensure the authenticity of credentials.

Committee Review and Decision

Credentialing committees or boards within CMS or the state Medicaid agency review the verified information and make credentialing decisions based on established criteria and standards set forth by the respective program. This review process includes evaluating the provider’s qualifications, competence, ethical conduct, and adherence to program requirements. If the provider meets the credentialing requirements, the committee approves the provider’s credentialing application for Medicare or Medicaid participation.

Contracting and Enrollment

Upon successful credentialing, the medical practice may enter into agreements with CMS or the state Medicaid agency to participate in the Medicare or Medicaid programs. These agreements outline the terms of participation, reimbursement rates, and contractual obligations specific to Medicare or Medicaid. Once agreements are finalized, providers are enrolled in the respective programs, allowing them to provide covered services to eligible beneficiaries.

Benefits of Working with TriumpHealth

Medicare and Medicaid Enrollment

Expert Guidance

Our enrollment specialists stay up-to-date with the latest regulations to ensure compliance with both federal and state requirements.

Accuracy

Meticulous attention to detail guarantees that forms are filled correctly on the first submission, avoiding time-consuming corrections and resubmissions.

Customizable Services

Whether you’re a solo practitioner or a large healthcare network, our services are scaled to your specific needs.

Continued Support

Post-enrollment, we remain at your beck and call for any updates or inquiries.

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.