Credentialing and Payer Services

Fotolia_51563344_Subscription_Monthly_MPayer credentialing is labor-intensive and tedious. Due to the requirements of regulatory governmental agencies and insurance providers, credentialing has become even more complex; it's no longer a part-time task.

The best credentialing requires full-time attention of trained specialists. PracticeForces understands there is little time for tracking the receipts and information necessary in credentialing medical office providers. That’s where we come in.

PracticeForces takes on credentialing tasks, allowing you and your staff more time to take care of patients.

  • Medicare/Medicaid provider enrollment and credentialing
  • Commercial insurance carriers
  • PECOS Enrollment
  • Managed care contracts
  • Adding a provider to a your practice
  • Out of network solutions for hospitalist and outpatient surgery centers
  • ERA (Electronic Remittance Advice) enrollment
  • EFT (Electronic Funds Transfer) enrollment
  • Address changes/updates
  • Credentialing and re-credentialing
  • Reimbursement issues, tracking of contract expirations and insurance contract negotiations
  • Completion of enrollment applications
  • Submission and tracking of enrollment applications
  • Preparation and continuous follow up for CAQH
  • Confirming if insurance networks are open for provider’s specialty
  • Requesting fee schedules from payor for provider’s review and approval prior to contracting
  • Archiving of documentations for future reference
  • Frequent communication with PracticeForces account representatives

Supporting Documentation for Enrollment

Supporting documents and required information for re-validation and new Medicare enrollment (CMS forms 855) include:

  • (For individual physicians) National Provider Identifier (NPI) user name and password
  • Group tax ID – IRS validation forms, preferably any CP forms. (example CP575)
  • Group NPI number, if you do not have one, we will submit the application for you
  • Drug Enforcement Agency (DEA) number and a copy of the certificate
  • Copy of State license number, if available
  • State of birth if in USA, if not provide the foreign country name and state of the provider
  • Copy of provider or signing authorities driving license
  • Copy of your green card or US passport immigrant status page (foreigners only)
  • Medical school information, name, location, graduation year and country
  • Owner / provider / Managing employee Social Security Number
  • Owner / provider / Managing employee DOB
  • Owner / provider / Managing employee home address
  • Electronic Funds Transfer documentation (EFT) Bank information with the copy of a voided check, ACH routing number, banking branch address and managers name, including phone number.
  • Your cell phone number, in case we require additional information.

Medicare Revalidation

The Affordable Care Act Section 6401 (a) mandates all healthcare providers (and suppliers) who accept Medicare patients to revalidate their Medicare enrollment records based on new enrollment screening standards. This requirement is only applicable to physicians who enrolled with Medicare before March 23, 2011. Physicians who enrolled with Medicare after this date won’t need to go through Medicare revalidation. 

Medicare Administrative Contractors (MACs) will officially notify each physician with the revalidation details and a request to start the credentialing process. Physicians cannot send their revalidation paperwork until they receive a notice from an MAC, at which point physicians have 60 days to respond. Approximately 300,000 healthcare providers and suppliers have to revalidate their Medicare enrollment data, based on The Centers for Medicaid and Medicare Services (CMS). MACs will regularly send out notices from now to March 23, 2015, so the final deadline for the Medicare revalidation initiative is May 2015.

Let PracticeForces Do Your Mandatory Medicare Revalidation Process For You

PracticeForce’s Medicare Revalidation Service costs $1250. Click here for more information.