Provider enrollment & Credentialing

Overview

Our professional credentialing staff will work with the insurance companies to get your practice providers enrolled with health plans and to maintain your providers credentialing files. We will serve as your primary point of contact for any payer enrollment/credentialing matters that may arise in your office.

 CAQH Universal Provider Datasource (UPD®) 

CAQH Universal Provider Datasource(UPD®) is the trusted source and industry standard for provider data needed in credentialing, claims processing, quality assurance, emergency response, member services and more.Most major insurance companies now require CAQH credentialing as the first step in the insurance enrollment process.
With a single, uniform online application, providerinformation is entered, managed,and updated to satisfy application requirements of participating health plans, hospitals and other managed care organizations. Updates and re-attests can be made instantly. Encryption technology keeps your data safe, so that only you control and authorize access to your information.

AQH credentialing is the first step prior to becoming in-network with the commercial carriers.

Commercial Insurance Provider Enrollment and Credentialing

Most insurance companies require providers to have a CAQH Universal Provider Datasource (UPD®) profile created before they will allow them to be credentialed or re-credentialed.UPD® is a system for centralized collection and distribution of all provider data to be used for credentialing. This means health plans and hospitals will be able to gather the provider information they need from one source and provider organizations will no longer need to respond separately to individual requests for information from each health plan and hospital they work with.

We will file credentialing applications to the commercial insurance providers that the you choose.  The insurance will verify the information provided regarding the status of your license, insurance, education and training with state agencies, accrediting bodies and other applicable entities.

If your credentials pass the primary verification, your application is sent to the credentialing committee. The credentialing committee reviews applications subject to their business needs and in accordance with applicable state law.

Upon successfully completing the credentialing process, you will receive a letter welcoming you to the provider network pending execution of your provider agreement.

Medicare Provider Enrollment

Medicare provider enrollment process involves submitting the appropriate Medicare Provider/Supplier Enrollment forms such as the CMS-855I, CMS-855B, CMS-855S, and CMS-855A.  Alternatively, the Provider Enrollment, Chain, and Ownership System (PECOS) can be sued to enter your enrollment application online.  The PECOS system uses your NPI login information to connect to the Medicare Provider Enrollment system.

We help prepare all of the necessary CMS forms for Medicare and Medicaid. We provide the following Medicare Enrollment services to practices across the country:

• PECOS Enrollment.
• 855i- Individual Medicare Enrollment
• 855r- Medicare Reassignment of Benefits
• 855b- Medicare Group Application
• CMS 588- Electronic Funds Transfer (required)
• CMS 460- Physician Supplier Participation Agreement

More information

Contact the EnrichMD Team at info@enrichmd.com to learn how we can help improve the financial and operational health of your organization.