Medicare Credentialing Service

Medicare Provider credentialing entails completing the necessary Medicare Provider/Supplier application forms, such as Medicare Provider Enrollment, Chain, and Ownership System (PECOs). PECOS is an online submission system that allows you to apply for and make adjustments to your registration record. Medicare Enrollment regulations are highly tight, so adhering to a strict degree of compliance for processing enrollment applications is required.

How Do We Out-Perform Others?

Medicare is frequently the largest payer for medical organizations, thus it is critical that the enrollment procedure is completed correctly the first time. The application process can be time consuming and complicated. There are numerous service providers available to help clinicians and organizations with the Medicare provider enrollment process. Having someone who is knowledgeable with the process on your side can save you time and headaches in the long run. Medicare is an essential payer for the majority of medical institutions, so be sure your enrollment is done correctly the first time and that your Medicare provider enrollment records are kept up to date.

Initial Requirements

Please verify that all required sections of the credentialing application are done and that the following information is provided:

Education or Training

Practitioner degree, post-graduate

  • Medical or professional education and training details
  • Completion of residency programme in the selected specialty

Certification and Licensing

  1. Current license or certification in the state(s) where the care provider will practice (no temporary licenses)
  2. National Provider Identification (NPI)
  3. Medicare eligibility or certification (if applicable)
  4. Work Experience Specifics
  5. Five-year work history of please explain any pauses longer than six months 

Insurance

  • Active professional liability (malpractice) insurance  

Other Credentialing Criteria

  • Such as an AMA profile or a criminal history check, as mandated by Credentialing Authorities
  • Notification if this provider has previously been a designated provider prior to the submission of this credentialing application.
  • Obtaining a passing grade on the state site visit (if required)

We may require additional information from you during the credentialing process that was not included in your application.

Requirements may differ depending on your location, type of care provider, or expertise. If we require additional information, we will provide the necessary documents and instructions.

Our Credentialing Specialists Will Enrolled You with Medicare

As soon as we get all of the required information, we can usually have your application completed within two business days! Once you provide us with the information needed to complete the application process, you will have no worries, as we will name ourselves as the contact person for the application process. We will also handle any questions Medicare may have regarding the application and will follow through to the end.

Call to get Your Medicare Credentialing done for you right away!

To Do First: When It Comes To Credentialing?

Health care providers who apply to join Medicare’s networks have the following credentialing rights:

  • To evaluate the information provided to support your credentialing application

Keep Information Safe& Secure With Us

It is critical to keep your enrollment information current. If you want to keep your Medicare billing credentials, you must disclose the following changes within 30 days.

  • A change in ownership a judicial action that is unfavorable
  • A shift in the site of the practise

All other modifications must be reported within 90 days. If you registered online, you can keep your information in PECOS up to date. If you applied on paper, you’ll need to resubmit your form to change your details.

Maintenance of Files

New applicants and lapsed members are common occurrences that can necessitate a significant amount of administrative effort and expense to keep up with. As a result, our file maintenance service is a cost-effective way to keep your membership current without the administrative overhead. Rather than relying just on file comparisons, we perform continuous outreach to ensure that membership is as accurate as possible. We work very closely with health plans to ensure that the most up-to-date information about membership is always available.

Customer Service

It’s important how you manage member service. We assist you in responding effectively, quickly, and with exceptional customer satisfaction. Our member contact center is staffed with customer service representatives (CSRs) who are trained to help members with program eligibility, provider identification, and healthcare quality reporting issues. Representatives have direct access to databases including information about health plans and individual accounts.

Re-credentialing

When you reach the three-year re-credentialing cycle, Medicare begins the procedure automatically. There’s nothing you need to do if you keep an up-to-date application and verify the data every 120 days. Your information will be automatically retrieved and reviewed for updates and changes. We’ll contact you if the location where you practise requires additional information not included in the usual applications.