Help with Insurance Credentialing …
You have landed on this page because you are looking for help with insurance credentialing. I know it can be very tedious work to do if you don’t know how to even get started. You have to go through insurance credentialing in order to become a participating provider and become contracted.
Getting into the CAQH
Most of the insurance companies are now utilizing the CAQH credentialing database system. This actually eliminates application forms to be required from the providers.It eliminates the snail-mailing of credentialing application packets!
It captures all demographic information of the provider to ease the credentialing process and in fact, it becomes faster and more efficient way. I am guessing, it may save it may save the provider at least 3-4 weeks of processing time for the insurance credentialing process.
Healthcare providers who wants to participate with the insurance companies can utilize caqh database system for the credentialing process. It may take approximately 2 hours to complete and enter all your demographic information on CAQH. So make sure you have everything ready, relaxed and have more than enough time when entering your data on CAQH Provider Credentialing database.
You can upload your all other related documents such as your professional liability insurance and copies your license and certifications.
After you are finished, you have to perform attestation. And if there is a problem, CAQH will let notify you if there is a need for you to provide additional information or there are missing information. They will also notify you if one of your documents is expired. They will then provide you with how to
fax them the missing information (such as a copy of an updated professional liability insurance).
CAQH credentialing is a database system where you will allow the insurance companies to look you up on your information through this database. Instead of you submitting application forms, they can look you up and all your related credentials, practice location addresses and your specialty and sub specialty.
You can authorize all insurance companies to view your data on CAQH or you can choose which insurance companies will you allow. You will be asked to attest and then review your entry to make sure you have everything entered on the system.
Make sure you have all the following documents .. (help with insurance credentialing)
1. NPI Number for the Individual Provider (s)
2. NPI Number for the Facility/Practice/Group
3. Practice Service Location Address/Telephone Number/Fax Number/Email Address (*Provide Mailing Address or Business Address if different from Practice Service Location Address)
4. TAX ID Number for the Individual/Group/Practice (with IRS letter – CP-575)
5. Profession Licenses, Certifications and CV
6. Malpractice Insurance (Professional Individual)
7. General Liability Insurance (for your Practice)
8. Copy of W9 (exactly what is shown on your IRS Letter / CP-575)
I can help you. I have more than 10 years of credentialing experience. As you know, credentialing can be very tedious work. I can be available to help you in the process of getting credentialed.
Let’s continue with Help with Insurance Credentialing
– let’s look at Medicare.
Via PECOS https://pecos.cms.hhs.gov/pecos/login.do online or using Paper Application
The Following are your Paper Application Forms
CMS 855I – For Physicians and Non-Physician Practitioners
CMSS 855B – For Clinics/Group Practices and Certain Other Suppliers. If you are a group of more than 2 individuals forming a medical group or a practice. This is the form you will use if you have business partners or business co-owners of the practice.
CMS855R – For Reassignment of Medicare Benefits (for your other providers joining the practice who are reassigning benefits only)
CMS 588 – for your EFT Authorization
CMS 460 –Medicare Participating Physician or SupplierAgreement
CMS 855S – Medicare Enrollment Form CMS 855s (01/13) For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers
** If you are a Sole Owner of your practice – you ONLY need the form CMS 855i (you don’t need the CMS-855R because you are not reassigning your benefits and you don’t need the CMS 855B). In addition to CMS 855i, you will need the CMS 588 and CMS 460 if you want to participate
*** If you are a Partnership or a Group – you will need the form CMS855i (for each provider), CMS855B (for the group) and CMS855R (for each provider reassigning benefits to the practice) plus CMS-588 and CMS-460
*** You can add the CMS-855s if you are applying as DME Durable Medical Equipment Supplier Provider (for example, if you are intending to provide OTS braces to your own patients as part of your services and will bill Medicare for it based on Medical Necessity)
Refer to your local CMS contractor. Go to their website and visit their “Enrollment” page to get more information on how you complete the enrollment forms.
Wondering what the insurance payers are looking for on a claim form before they process your claims? Besides of course, the patients information, procedure codes, number of units and the diagnosis codes.
Either you are non-par or a par provider, these information should and must appear on your claims. Remember your credentials and practice billing is associated with your Billing TAX ID and Billing NPI Number. See below.
Do you need help with insurance credentialing? .. please contact me. With my Highly Qualified Team of Consultants, we are here to help.
We can help you get on board to as many insurance panels possible as long as the market is open in your area! My successes are a proof that I can negotiate fees and contracts! I can help you get it done… the right way. Let’s talk today, Doctor!