Credentialing is a complex process that requires a lot of documentation and verification to become part of an insurance network. A simple error or missing form can delay enrollment and result in a significant loss of revenue by making that network’s patients inaccessible to you.
Medcare MSO stands out as the premier provider of medical credentialing services in the US. We simplify the process so that you can focus on your core mission. Our experts handle credentialing tasks efficiently, from primary source verification to premium network enrollment.
Since 2012, Medcare MSO has helped healthcare providers accelerate credentialing and enrollment. Our proven 95% success rate ensures your process is completed efficiently, enabling providers to navigate the credentialing process effectively, saving you valuable time and minimizing administrative burdens. We offer a comprehensive suite of physician medical credentialing services designed to meet the needs of specialties of all sizes, including primary source verification and credentialing workflow automation.
Negotiation is required with each insurance payer to get the most favorable terms and maximum reimbursement. Our credentialing experts assist physicians with insurance payer contract negotiations for optimal service terms and network participation.
We assist providers in obtaining and renewing state medical licenses, which is crucial for any medical practice to ensure compliance and enhance revenue. The rules and regulations for issuing licenses to healthcare professionals differ by state. Obtaining and renewing state licenses can benefit providers in three ways: compliance, competence, and liability protection.
All qualified practitioners who write controlled substance prescriptions must hold a federal Drug Enforcement Administration (DEA) certificate.
Our healthcare credentialing services include the application and renewal processes for DEA certificates. We enable medical providers to prescribe and handle controlled substances according to their specialty.
Most insurance plans have a backlog of credentialing applications. Medcare MSO makes sure that your application gets received. We check regularly to see where it is in the process. Our dedicated team maintains a record of all ongoing follow-ups until the application is approved and participation is confirmed.
Application errors may result in delays and denials. Our diligent team ensures your application is complete and gets approved the first time it is submitted. We carefully submit your practice address, license, fax, contact information, services provided, and any other records of experience to prevent delays or denials.
Our physician credentialing services comply with the National Committee for Quality Assurance (NCQA) standards. This provides our clients access to preferred partnerships and networks, ultimately expanding your patient base.
We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements
We will verify your credentials with the issuing bodies. Our expert team will double-check everything with the official sources. Once everything is in order, we will assist you in obtaining approval from hospitals and insurance companies.
Contact Medcare MSO to discuss the details of your organization and health plans for enrollment.
Our team will complete the appropriate applications and submit them to your preferred payers
Contact Medcare MSO to discuss the details of your organization and health plans for enrollment.
We will assemble all the necessary information, such as licenses, certifications, education transcripts, and references, to meet each payer’s specific requirements.
Our team will complete the appropriate applications and submit them to your preferred payers.
The necessary documents vary depending on the insurance plan and the type of physician/practitioner. The following is a list of some fundamental documents that are typically needed:
Personal documents:
Additional required documents:
Documents required for your legal entity:
While credentialing is a necessary process there are common mistakes healthcare providers can make that can cause delays, denials or even loss of revenue. Here are some:
By doing this medical practice can have a seamless credentialing process for their patients, practice and revenue.
Medicare enrollment for regular providers takes 2-3 months but allows retroactive billing. Note that this period can vary from state to state. For DMEPOS suppliers, expect a longer wait due to stricter confirmation, including a site visit.
CP575 is an IRS notice that confirms your business’s Employer Identification Number (EIN). It’s basically a confirmation letter saying your business tax ID application was successful.
This letter serves as additional verification of the business’s legal name and must be submitted with the Medicare enrollment application. If the original is unavailable, a replacement letter (147C) can be requested as proof of the EIN. Medicare accepts only these two documents as proof of the EIN.
The specific Medicare application used for provider enrollment depends on the type of provider enrolling. Here’s a breakdown:
You can find these forms and more information on the official CMS website:
In most cases, yes, providers must have a service location to begin credentialing for Medicare. Providers cannot use their home address as a clinic address, either permanently or temporarily.
While some exceptions might exist, a home address can be used for billing and correspondence, as long as a physical business address is also provided. This works even if the office is still under construction. The application can be submitted up to 30 days before the location opens for patients. Most commercial carriers have the same policies.
Are you ready to experience a streamlined and efficient credentialing process? Partner with Medcare MSO and let our expert team provide you with smooth and efficient physician credentialing services.
We guarantee to accelerate the credentialing process, submit clean claims, and maximize your revenue potential by up to 30%.
A member of our team will get in touch with you in 12 hours.
800-640-6409
