In order to get paid by Medicare and Medicaid, a provider needs to be credentialed. When it comes to medical credentialing services, Newport submits all the required forms and documentation and then actively follows up with each payer to get your providers enrolled and keep them enrolled with all of their Medicare & Medicaid plans.
- PECOS Provider Assessment – Our account management team will assess all of your providers and identify which ones have not updated or initiated their PECOS accounts and take appropriate steps to keep their accounts active.
- PECOS Account Management – Our team manages all PECOS updates for your providers.
- Enrollment Application Processing – All payer applications are prepared, formatted, and sent to the provider for signatures.
- Quality Assurance – Situational and Organizational QA processes ensure accurate and complete information is sent to the payers.
- Application Follow Up – Rigorous and regular follow up is conducted on each application.
- PIN Compilation – Received PINs are immediately sent to our client’s billing team to be entered into their patient accounting system.
- Out-of-State Medicaid Enrollment – Newport can make sure that those frequent or infrequent visits from out-of-state Medicaid patients get reimbursed.
- Medicare Revalidation – Medicare revalidation due dates are automatically updated each month in Newport’s credentialing system and promptly managed by our medical credentialing services specialists.
Medicaid & Medicare Provider Enrollment and Credentialing
After a provider completes their post-graduate residency and is sufficiently trained in their area of expertise, then they are able to get hired. Once hired, the credentialing team is notified and the enrollment process begins.
For a provider joining a multi-specialty group with 100 providers in multiple locations or a large hospital with 500 full-time faculty members, it is not uncommon for multiple practitioners to be brought on within the same timeframe. This means, in addition to managing re-enrollments for existing providers, additional time is required to ensure the new provider(s) is properly enrolled in all the plans a hospital participates in, including Medicare and Medicaid.
Diligent follow-up is required to ensure no unnecessary delays occur along the way. Because Medicaid is managed on a state-by-state basis, additional attention must be paid to providers practicing in multiple locations that cross state lines. Otherwise, if a provider is not properly enrolled they can’t bill for services. In addition to the financial impact, patient satisfaction will suffer if a hospital accepts Medicaid/Medicare but the provider the patient sees doesn’t.
To ease the burden of Medicaid and Medicare provider enrollment, enlisting the help of an outside partner is an increasingly common practice. Newport’s expert medical credentialing services and provider enrollment specialists will conduct the necessary research to get a provider enrolled as quickly as possible so they can start billing. Our team of specialists will initiate a Par- Non-Par analysis to the various payers the provider wants to be enrolled with to determine if the provider is already participating in any plans. If a plan does not have a record for the provider in their system, Newport will move forward with an initial enrollment application which can be easily 10 – 50 pages depending on the plan. Applications need to be filled out, provider signatures obtained and all necessary documentation attached and submitted to the plan for enrollment. Once submitted the enrollment process can take anywhere from a couple of weeks to 180 days depending on the plan.
Newport’s cloud-based CARE medical credentialing services and Medicare provider enrollment platform allows staff to easily track provider enrollment status along the way as well as speed the application process. Newport’s CAREscan application allows users to easily scan and store primary source documents in the cloud as well as to auto-populate applications and/or forms directly from the database. Medicaid and Medicare Provider Applications can be auto-populated directly from the CARE database using easy to use mapping technology. The ability to map each data element in the database to the specific field on the credentialing application is a true time saver.
Newport’s CAREreport platform provides department-based summary reports that depict current enrollment status (Par, Non-Par, In-Process) and the financial impact of In-Process applications. CAREreport provides top In-Process Providers and Payers and links Provider Charge Data to each In-Process application. Newport’s enrollment team will generate a regularly scheduled reports detailing enrollments status. Once a welcome letter or call is received from a plan confirming a provider is Par, the enrollment status will be updated within the system and the provider will no longer appear on the report as necessary for follow-up. If you have any questions about the Medicaid & Medicare provider enrollment process, please feel free to contact us.