Revalidation and recredentialing cause more confusion than almost any other administrative requirement providers face. You’ve spent years in school, completed your residency, passed your boards, and got credentialed with insurance companies so you can actually get paid for treating patients. Then someone tells you that you need to handle “revalidation” or “recredentialing,” and the paperwork […]
Credentialing Timelines, Medicare Revalidation, Payer Credentialing, PECOS, Provider Enrollment, Recredentialing
The most common credentialing delays are caused by incomplete applications, mismatched provider data, expired CAQH profiles, incorrect NPI usage, closed payer panels, and communication breakdowns. Each of these is preventable. Yet, only if you know where to look before the application is submitted. If you work in healthcare administration, you already know the financial stakes. […]
Insurance Credentialing, Medicare Enrollment, NPI, NPPES, PECOS, Provider Enrollment
PECOS, the Provider Enrollment, Chain, and Ownership System, is the CMS web-based portal through which healthcare providers and suppliers enroll in Medicare, update their enrollment information, and manage their participation status. Any provider who wants to bill Medicare for services must have an active, accurate PECOS enrollment record. Billing Medicare without an active enrollment, or […]
CMS, Medicare, Medicare Enrollment, PECOS
Provider credentialing is how insurance companies and hospitals confirm that a provider holds the qualifications they claim, then approve that provider to bill inside their network. Without it, there’s no Medicare or Medicaid billing and no commercial reimbursement, however well trained the provider is. Plan on 90 to 120 days with most commercial payers. It […]
CAQH, CPCS, Credentialing Lifecycle, CVOs, NPPES, PECOS
Medicare credentialing, which CMS calls enrollment, happens in PECOS, and the Medicare Administrative Contractor (MAC) for your region decides whether to approve it. Get the application right and you can bill Medicare. Get it wrong and the MAC sends it back with a request for more information that you have 30 days to answer. This […]
Credentialing, Medicare, Medicare Credentialing, PECOSAfter years of anticipation, CMS has officially launched PECOS 2.0, a ground-up rebuild of how providers enroll in and maintain Medicare participation. This isn’t a cosmetic redesign, it changes daily workflow for anyone who touches Medicare enrollment, credentialing, or revenue cycle operations. Understanding what’s actually different in PECOS 2.0 keeps payments flowing and applications out […]
CMS, Medicare Billing, Medicare Enrollment, PECOS, Revalidation
Credentialing for healthcare providers, hospital groups and facilities is a tedious task that often requires a team of specialists to handle all the on-boarding information, as well as updates throughout the year. As of April, 2018, CMS now mandates that providers maintain accurate information and timely updates. Providers and facilities that do not keep up […]
CAQH, Credentialing Applications, In-Network, NPPES, PECOS, Primary Source Verification