PROVIDER ENROLLMENT SERVICES
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Becoming A Medicare Provider
What is Provider Credentialing?
Credentialing is an in-depth review process to verify a healthcare provider’s qualifications to ensure they can provide care or services to patients. The process includes obtaining and assessing documented evidence of a provider’s licensure, education, training, career history, and other qualifications from a primary source (such as a medical school). It also includes submitting applications for data and other processes, like malpractice claims review.
WHAT WE DO:
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MEDICAID APPLICATION PREPARATION: We help clients complete and submit the necessary Medicaid provider applications, ensuring that all required information is accurate and up-to-date.
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FOLLOW-UP COMMUNICATION: We liaise with Medicaid agencies on behalf of our clients, facilitating communication and addressing any inquiries or requests for additional information during the enrollment process.
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PROVIDER CREDENTIALING: We assist clients in the credentialing process, which may involve verification of qualifications, background checks, and ensuring compliance with Medicaid provider standards.
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MEDICAID BILLING SETUP: We help clients set up their billing systems and procedures to ensure accurate and efficient claims processing and reimbursement.
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MEDICAID COMPLIANCE: We provide guidance on Medicaid compliance requirements, helping clients understand and meet the regulatory standards necessary for provider enrollment.
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PROVIDER EDUCATION: We offer training and education to help clients stay informed about changes in Medicaid regulations and requirements.
CALL 215. 717.8686 NOW TO GET STARTED
MEDICAID PROVIDER ENROLLMENT
MEDICARE PROVIDER ENROLLMENT
WHAT WE DO:
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MEDICARE APPLICATION ASSISTANCE: We guide clients through the Medicare provider application process, ensuring all necessary forms are completed accurately and submitted on time.
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DOCUMENT PREPARATIOIN: We help gather and organize the required documents and credentials, such as licenses, certifications, and insurance, to meet Medicare's standards.
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COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with all Medicare regulations and requirements, including the Centers for Medicare & Medicaid Services (CMS) guidelines.
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REDENTIALING SUPPORT: Our team assists with the credentialing process, including the enrollment of individual healthcare providers to ensure they can bill Medicare for services.
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BILLING SYSTEM SETUP: We help clients establish effective billing systems and procedures to submit claims to Medicare accurately and efficiently.
CALL 215. 717.8686 NOW TO GET STARTED
WHAT WE DO:
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INSURANCE VERIFICATION: We help healthcare agencies determine which private insurance payers they should enroll with based on their services and target patient population.
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APPLICATIOIN ASSISTANCE: We guide clients through the application process for each selected private insurance payer, ensuring all required forms and documents are completed accurately and submitted on time.
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CREDENTIALING SUPPORT: We assist with the credentialing process, ensuring that individual healthcare providers within the agency are properly enrolled with private payers to bill for services.
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DOCUMENT PREPARATION: We help gather and organize the necessary documents and credentials, such as licenses, certifications, and insurance, to meet each private payer's standards.
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COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with the specific requirements and regulations of each private insurance payer.
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BILLING SYSTEM SETUP: Our team helps clients establish effective billing systems and procedures to submit claims to private payers accurately and efficiently.
CALL 215. 717.8686 NOW TO GET STARTED
PRIVATE PAYER/INSURANCE ENROLLMENT
ACHC ACCREDITATION
WHAT WE DO:
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INITIAL ASSESSMENT: We conduct a comprehensive assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet ACHC standards.
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POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with ACHC accreditation standards.
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STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement ACHC compliance requirements effectively.
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MOCK SURVEYS & READINESS REVIEW: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official ACHC accreditation survey.
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DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets ACHC standards for submission.
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ACCREDITATION APPLICATION ASSISTANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.
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ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by ACHC surveyors.
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SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.
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CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with ACHC standards after accreditation is achieved.
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CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.
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ACCREDITATIOIN RENEWAL: We help agencies prepare for the renewal of their ACHC accreditation, ensuring continued compliance.
CALL 215. 717.8686 NOW TO GET STARTED
WHAT WE DO:
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INITIAL ASSESSMENT: We conduct a thorough assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet The Joint Commission standards.
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POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with The Joint Commission's accreditation standards.
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STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement The Joint Commission's compliance requirements effectively.
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MOCK SURVEYS & READINESS REVIEWS: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official Joint Commission accreditation survey.
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DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets The Joint Commission's standards for submission.
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ACCREDITATIOIN APPLICATION ASSITANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.
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ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by Joint Commission surveyors.
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SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.
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CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with The Joint Commission's standards after accreditation is achieved.
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CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.
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ACCREDITATION RENEWALS: We help agencies prepare for the renewal of their Joint Commission accreditation, ensuring continued compliance.
CALL 215. 717.8686 NOW TO GET STARTED
THE JOINT COMMISSION ACCREDITATION
Payor Enrollment vs. Credentialing
While medical credentialing is an essential process to certify a provider’s qualifications, payor enrollment is the process of requesting participation in a health insurance network as a medical provider. This can include major commercial payors such as UnitedHealthcare, BlueCross BlueShield, Humana and Aetna, for example, regional insurance networks, or government public programs such as Medicaid and Medicare.
Many practices consider payor enrollment a crucial first step in the revenue cycle. As healthcare costs have surged over the years, patients have experienced a nearly 30% increase in deductible and out-of-pocket maximum costs. That has led to fewer patients choosing to see providers who are out-of-network, refusing to cough up higher copays. Instead, patients choose providers who are in-network and covered by their insurance.
It is strongly advised that providers do not see patients before the completion of this step as reimbursement is not retroactive and doing so could lead to lost revenue.
Our credentialing services include:
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Provider enrollment services for physicians and healthcare entities (credentialing and contracting with health plan
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We guide your practice administrators and providers in gathering the required demographics and background information.
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We submit the CAQH (Council for Affordable Quality Healthcare) application for providers who must use this service to credential with individual payers.
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Once we have all the required documentation, we prepare and submit the required applications to the payer organizations.
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We manage all-payer communications, verifications, and follow-up activity and tasks.
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We work with you to ensure credentials are up-to-date year after year.
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Medicare provider enrollment and re-validation services
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Credentials verification for physicians and ancillary healthcare providers
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Network management for health plans
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Managed care contracting
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Healthcare administration consulting services
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Our staff will work with any insurance companies to get your practice providers enrolled with health plans and to maintain your providers credentialing files.
Benefits Of Our Program:
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Keep all your credentialing information in one place.
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Years of experience to navigate through the process of Medicare and Medicaid provider enrollment, Commercial Insurance Provider Enrollment, and other healthcare provider credentialing needs.
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Status reports keep you up to date on the progress of your credentialing
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You and your medical office staff can focus on more important patient matters than dealing with enrollment paperwork
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Data entry of paper applications
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Ongoing monitoring services
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Application mailing service
Features Of Our Program:
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We make all the calls, follow-ups, & submit all applications, e-mails & faxes for you!
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Dedicated Account Manager
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24/7/365 Availability
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Provider Portal and Practice Manager Portal
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Automated Alerts & Renewals
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Secure Document Storage
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Compliance Reports & Dashboard
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Pay as you go model – no long term contracts – cancel anytime