Medicare Insurance Credentialing and Provider Enrollment Services

Medicare Insurance Credentialing

To get paid for medical services provided, many healthcare professionals need to be credentialed with insurance companies. A wide range of both public and private medical professionals offer Medicare services, but the credentialing process can be lengthy. This is why many clients turn to us at Bikham Healthcare for help through the process of Medicare provider enrollment.

If you are a physician who wants to be able to bill Medicare directly, partner with us at Bikham Healthcare. We specialize in Medicare credentialing services to help healthcare practitioners, physicians, hospitals, dentists, physical therapists and chiropractors who want to become in-network providers.

Bikham Healthcare's Medicare Credentialing Services

If you are looking for Medicare insurance credentialing, look no further than Bikham Healthcare. Because we specialize in Medicare credentialing, we offer several helpful services, including:

  • Application filing: We will send you a checklist comprised of all the documents and information you need to file your applications. Once we have these details from you, our team will file the appropriate contract applications. We will work to ensure your submission is flawless so you can enjoy the shortest turnaround time possible.
  • Network research: At Bikham Healthcare, our credentialing team is highly experienced in enrolling physicians with Medicaid, Medicare and commercial payers. We can ensure your group or practice has a varied, effective mix of popular payers. We can reach out to every shortlisted payer you want to enroll with and get you an accurate timeline.
  • Out of network enrollments: If you decide to stay out of network or are forced to do so due to closed panels, we offer out of network enrollments. We will help you through every step of the process so your practice is in Medicare's system and you can begin receiving payments as an out of network provider.
  • EFT and ERA enrollments: We can also help you set up EFT and ERA enrollments.
  • Demographics: If you have demographic changes, whether basic or complex, we can handle these changes for you. Changes may include updating your bank account, address or TAX ID.
  • Contract negotiations: We will negotiate contracts and fee rates for you. For your convenience, we maintain a database of every payer's latest fee schedule. We also revisit older contracts to get you better rates per the payer's availability.
  • CAQH and PECOS set up: It is crucial to stay up to date on CAQH and PECOS profiles. We will maintain these profiles for you, ensuring all your information is compliant and accurate.
  • Application follow up: To ensure your application has been received and is in Medicare's system, our enrollment team will follow up on your submitted application every two weeks. We will also review whether additional information has been requested. Until the contract is delivered to your location, we will follow up regularly.
  • Appeals for closed panels: Some payers have closed panels in particular areas, and we can file an appeal that outlines your services. These details are included in your business plan and will be submitted to Medicare's senior provider representatives. Though it can be tough to overturn closed panel decisions, we have a success rate of 30%.
  • Annual credentialing maintenance: If you have a larger healthcare facility with several providers, you need accurate provider database management. On our credentialing portal, we maintain and manage all your providers' credentials data. We specifically designed this tool to be transparent, comprehensive and HIPAA-compliant.

  • How to Enroll in Medicare as a Provider

    How to Enroll with Medicare

    How can you get credentialing with Medicare? Though the process may vary depending on your specialty and industry segment, you can follow these general steps to get credentialing with Medicare as a new provider:

  • Receive an NPI: As a provider looking to get credentialed with Medicare, you will need to get a National Provider Identifier, also known as an NPI. You can complete and submit your NPI application online, or you can download it and mail it in.
  • Buy medical malpractice coverage: If you have not already, now is the time to purchase a medical malpractice insurance policy. While applying for Medicare, you may be asked to provide a copy of your declaration page.
  • Access PECOS: Your next step is accessing PECOS, the Medicare enrollment system for suppliers and providers.
  • Collect the necessary documentation: Gather the documentation you need for your application. You may need your NPI number, state license, resume and declaration page from your malpractice insurance policy.
  • Complete your Medicare enrollment application: After you obtain your NPI, you can complete your Medicare provider enrollment application. This application can be completed through PECOS. Though this system is intended to be paperless, you can also print a copy for your records.
  • Contact phone support if needed: If you need additional assistance while completing your application, you can reach out to Medicare phone support, which can provide you with the help and knowledge you need.
  • Work with your Medicare Administration Contractor (MAC): Your MAC depends on the region where your practice is located, and they could request additional information while processing your application. For an update on your enrollment status, you can also reach out to your MAC.
  • Pick a specialty designation: If applicable, you may need to choose a specialty designation. For example, if you are a psychologist, you will need to select either the independently practicing psychologist designation or the clinical psychologist designation.
  • Pay the application fee: For initial enrollment, you will also need to pay an application fee for Medicare provider enrollment. You will need to pay an application fee if you ever need to re-validate your enrollment as well.

  • When you enroll with Medicare as a new provider, you will be able to treat Medicare beneficiaries like younger disabled people and seniors. To learn more about how to get credentialed with Medicare, you can reach out to us at Bikham Healthcare.

    Medicare Application Process to Become a Provider

    Medicare Application Process to Become a Provider

    If you are interested in Medicare new provider enrollment, you need to know how to complete the Medicare credentialing application. You will need the following forms to meet Medicare credentialing requirements:

  • CMS 8551, also known as the Medicare Enrollment Application
  • CMS 588, also known as the Electronic Funds Transfer Authorization Agreement
  • CMS 460, also known as the Medicare Participating Physician or Supplier Agreement

  • Follow these tips for completing your Medicare application:

    • Date the signature page:Remember to date the signature page, as failure to do so could result in a delay in the acceptance of your application.
    • Complete the demographic information: In Section 2, be sure to complete the demographic information.
    • Enter the same business name shown by the IRS: The business name should be listed exactly as it is by the IRS, including the entity designation like LLC or Inc. The business name on your form and on your CP-575 should be an exact match.
    • Use the correct name: The name of the individual entered should be the same as the record from the Social Security Administration.
    • Include a valid bank account verification letter or voided check: If you include a pre-printed voided check or a bank account verification letter, it should list the company name exactly as it is listed on the CP-575.
    • Provide the applicant's direct correspondence and phone number: The address and phone number cannot be for a billing company or another third party.
    • Sign in blue ink: Be sure to use blue ink when signing the form. Applications have been rejected after being signed in black ink, as the processor of the form claimed this was a signature stamp rather than a personally signed document.

    Hurdles of Getting Credentialing With Medicare

    You may face some challenges while trying to get credentialed with Medicare as a new provider. Delays are often one of the major hurdles and are frequently a result of missing signatures and incomplete or inaccurate application information. The best way to move the process along quickly is by ensuring there are no errors and that the application is successfully processed on your first submission. If errors are found, you will need to dedicate additional time to providing more information or fixing errors.

    Follow these tips to complete your Medicare application accurately:

    • Attach all the necessary supporting documentation.
    • Fill out each page of your application in its entirety.
    • Use the most recent versions of the Medicare forms.
    • Sign and date your application in every necessary space.

    Another way to avoid the hurdles of getting credentialing with Medicare, is partnering with us at Bikham Healthcare. We can help you through each step of the process.

    Medicare Credentialing Guidelines

    Medicare Credentialing Guidelines

    When pursuing Medicare credentialing, there are some guidelines you may want to keep in mind. You should maintain your enrollment information to keep it up to date. Your Medicare billing privileges can be revoked if you fail to do so. To comply, report any of the following updates:

  • Change in practice location
  • Change in ownership
  • Adverse legal action

  • These changes should be reported within 30 days, while other changes should be reported within 90 days. For a paper application, you can update your information by resubmitting your form. For an online application, update your information in PECOS.

    To keep your billing privileges with Medicare, you are also required to renew or re-validate your enrollment record from time to time. Generally, providers must re-validate their enrollment records every five years. An off-cycle re-validation may also be requested. You can re-validate your enrollment record online with PECOS. PECOS allows you to review your information on file, upload any supporting documentation, sign the re-validation electronically and submit it online.

    If you do not re-validate on time, it could put a hold on your reimbursement from Medicare or lead to your billing privileges being deactivated. If this happens, you will need to resubmit a complete application to get your Medicare billing privileges back.

    Benefits of Bikham Healthcare Helping You With Medicare Credentialing and Enrollment

    When you choose to work with us at Bikham Healthcare for Medicare credentialing and enrollment, you can enjoy the following benefits:

    • Complete assistance: At Bikham Healthcare, we can provide your billing team with full assistance.
    • Alerts for expiring documents: Additionally, we will send you real-time alerts if you have expiring documents.
    • Fast completion of applications: We can get your application completed faster than in-house teams to get you enrolled with Medicare as soon as possible.
    • Application status updates: In real time, you can find out the status of your applications.
    • Dedicated account manager: For your account, we will provide a dedicated account manager to work with you through the credentialing and enrollment process.
    • Experienced team: When you choose Bikham Healthcare, you will partner with our team members who are highly experienced in Medicare enrollments.
    • Fixed prices: We offer fixed prices per application, so you won't have to worry about any hidden fees.
    • High approval rate for first-time applications: At Bikham Healthcare, we are proud to have a higher rate of approval for first-time applications than our competitors.

    When you hand over the tasks for Medicare credentialing and enrollment, you will be able to dedicate more of your time to focusing on patient care and the other crucial tasks of maintaining your healthcare practice.

    Who Can Bikham Healthcare Help With Medicare Credentialing?

    Who can utilize our Medicare credentialing services at Bikham Healthcare? Over our 18 years of service, we have successfully filed more than 232,000 applications in 50 states. No matter where you are practicing, we have extensive experience in every state to ensure compliance. We enroll several specialties and serve various industry segments. The specialties we enroll include the following:

    • OBGYN
    • Durable medical equipment
    • Laboratory
    • Cardiology
    • Physical therapy
    • Urology
    • Chiropractic
    • Sleep medicine
    • Orthopedic
    • Behavioral health
    • Radiology
    • Internal medicine
    • Rehab billing
    • Surgery
    • Anesthesiology

    • Additionally, the industry segments we serve at Bikham Healthcare include:

      • Physician group practices
      • Hospitals
      • Ambulatory surgical centers
      • Durable medical equipment providers
      • Medical laboratories
      • Skilled nursing facilities
      • Teleradiology and telehealth

        Contact Bikham Healthcare for Medicare Insurance Credentialing and Enrollment

        Physicians, hospitals, physical therapists, dentists and chiropractors can face difficulties when trying to get approved for credentialing with an insurance payer, which is why Bikham Healthcare helps a range of healthcare professionals get connected and credentialed with Medicare. Regardless of whether you are just starting your practice or you already have an existing practice, we can help you bill Medicare as an in-network provider.

        When you get credentialed with Medicare, you can maximize your patient outreach. With the help of Bikham Healthcare, you can avoid some of the enrollment process complexities. For Medicare insurance credentialing and enrollment, contact us today.

        Contact Bikham Healthcare for Medicare Insurance Credentialing and Enrollment