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.
Medicare Carrier Request, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (MCR DMEPOS) enrollment is the process required by Centers for Medicare & Medicaid Services (CMS) to be allowed to provide these specific products and services and bill Medicare for them. Our physician credentialing services help you enroll in the Medicare DMEPOS program, enabling improved quality of care and streamlined Medicare reimbursement. DME medical billing services further support this process by ensuring accurate billing, compliance with Medicare guidelines, and timely reimbursement for DMEPOS items and services.
The medical credentialing process with each health insurance company can be lengthy due to varying eligibility criteria and plan complexities. The process can take several months before you can start seeing their patients, so we make sure there are no additional delays due to missing information.
Our expert team gathers and organizes all required documentation, including licenses, certifications, and training records, ensuring seamless credentialing with commercial insurance payers like Humana, Cigna, UnitedHealthcare, and Aetna you get credentialed with commercial insurance payers like Humana, Cigna, and Aetna.
Credentialing with an insurance company involves several steps, including submitting an application, providing necessary documentation, and undergoing a review process. Being recognized as an in-network provider is crucial for medical practices. MedCare MSO stands out as the premier provider of medical credentialing services in the US, simplifying the process from application submission to network enrollment.
Our credentialing specialists register and maintain your provider’s profile on the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView). Credentialing with multiple insurance companies is essential to manage payment claims effectively and ensure operational efficiency. This streamlines the medical credentialing process with multiple health plans.
We assist medical practitioners to enroll in Medicaid and Medicare, which are the largest insurance programs in the United States. Understanding the insurance credentialing process is crucial, as it involves adhering to specific requirements and overcoming potential challenges such as thorough research and proper communication with insurers. This leads to a wider patient base and, potentially, a lot more revenue for their practices.
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.
Practitioners and laboratories that perform tests for disease diagnosis, prevention, or treatment must be registered in accordance with the Clinical Laboratory Improvement Amendments (CLIA). We assist healthcare providers with the CLIA registration process, enabling them to provide testing services to patients.
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.
Credentialing is a time consuming and complex process but can also reduce administrative burden in the long run. By outsourcing credentialing services, healthcare providers can free up staff time and resources to focus on more important tasks. Credentialing can also streamline the billing and reimbursement process reducing the administrative burden of those tasks. So healthcare providers can focus on patient care without being bogged down by administrative headaches.
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.
Credentialing documents vary by insurance plan and practitioner type, but most applications require the following. Personal documents include a current CV (listing your present employer, all entries in mm/yy format), DEA and state Controlled Dangerous Substances (CDS) certificates, malpractice insurance (Certificate of Insurance), a current driver’s license, board certification(s), practitioner license(s), and a diploma or highest-education copy (required for non-MDs/DOs). Depending on circumstances, you may also need a Collaborative Agreement (Nurse Practitioners), an ECFMG Certificate (if educated outside the US), a Letter of Admitting Arrangement (if you lack hospital admitting privileges), a passport or citizenship documents (if born outside the US and not previously enrolled with Medicare), and a Letter of Prescribing Arrangement (physicians without a DEA certificate). For your legal entity, prepare IRS Form CP575 or letter 147C (EIN verification), Form W-9, a CLIA Certificate, an office lease copy (therapy facilities), a business license, and a bank account verification letter (Medicare enrollment).
While credentialing is necessary, common provider mistakes can cause delays, denials, or lost revenue. Incomplete or incorrect applications are a frequent culprit, missing or wrong information leads to delays or denials, so accuracy is essential. Missing deadlines or failing to follow up with insurers also causes major delays, making timely submission and regular follow-up key. Providers should always verify credentials and qualifications before submitting to avoid rejections, and keep all provider information current, since outdated details create problems during re-credentialing. Finally, monitor applications regularly and fix issues quickly as they arise. Avoiding these mistakes ensures a seamless credentialing process for 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. Physicians and non-physician practitioners use form CMS-855I, while group practices, clinics, and certain other suppliers enroll with CMS-855B. Institutional providers submit CMS-855A, and physicians and non-physician practitioners who only order and certify use CMS-855O. Finally, DMEPOS suppliers enroll using CMS-855S, though this form may be undergoing revisions.
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 35%.
Please provide the following information, so our team can connect with you within 12 hours.
Or call us as 800-640-6409
