Medicaid / Medicare Applications
Medicare Enrollment is a choice for all providers.
Most providers choose to participate because of our aging population and the movement of managed care to the senior affordable plans. Medicare can make up at least 15-25% of a practice claims depending on the practice specialty.
Medicare enrollment usually will take 6-8 weeks for an initial enrollment and 4-6 weeks if you are re-assigning your benefits to another provider. If the enrollment is missing information or there is any miscommunication on the application it can be delayed, or even worse, it is sent back to be corrected and re-submitted.
Specialized Medicare Expertise
Our staff has extensive experience with Medicare applications. We work closely with Medicare to make sure the information being submitted is correct both for the type of provider and specific situation.
What you need to know and have available to start an application:
- Know what form to use: Are you a sole proprietor or group?
- What is the Legal name of the group or provider being enrolled excluding punctuation marks?
- Does the legal name on the application match the name in the NPPES registry?
- As an individual, you must state your date of birth, SS#, state, and country you were born in, state license with initial and expiration date and addresses for location (including suite), correspondence address and special payments address, ownership and management information.
- All new enrollments must have and EFT application (CMS 588) with Legal name, practice address banking information including a bank contact with phone and email.
- Providers will need to complete a CMS 460 if they want to be a PAR provider.
- There are many tips that save time and help complete the timely enrollment. We can help.
- There is no expiration for your Medicare number (PTAN) but there is Revalidation which occurs every five years. Medicare will ask you to update and correct your information in PECOS. This is a time-sensitive request, it is generally done online in PECOS. PECOS can be intimidating but also gives you a better picture of your practice information with Medicare.
- Our program provides a current Universal Application that is updated as information and documents change
- Updates and expiration dates are reported monthly or on request
- Facility and Payor credential activity is reported for each professional
- Provides custom reports, letters, and specialty-specific data
- CAQH submission and maintenance every 120 days and recorded
- Medicaid Enrollment and Maintenance
Medicaid enrollment also can be intimidating and requires much of the same information as Medicare. The application is done online and updates are done on request when credential documents are expiring.
Medicaid contracts do have an expiration date. These are done by type of provider and usually done every three years. Oklahoma MD’s and DO’s were recently re-enrolled from July to September. If a provider misses the re-enrollment, their number is de-activated and they must do a total new enrollment. It is part of our job to keep our providers informed of when these events are happening and help with the process.