Credentialing Service for Provider Enrollment

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By signing up for our credentialing service, we can aid you with provider enrollment and becoming affiliated with insurance companies so that you can receive third party reimbursement. While just a few years ago health professionals considered medical credentialing “optional” for building a practice, today it has become more necessary than ever for providers to be networked with insurance companies. Learn how PrognoCIS can help you get the proper credentials to open a medical practice.
When have gathered your documentation and are ready to get started –Contact us. We work with large 30+ provider practices as well as 1 and 2 provider practices for both Medicare, Medicaid, and Commercial Payers for group and individual enrollment.

Graduation

Benefits of PrognoCIS Credentialing include:

  • Faster enrollment with third-party payers
  • Quickly begin seeing patients
  • Credentialing specializing in all 50 states
  • Discounted pricing available for multiple panels
  • Save time and let us do the “paper work” for you
  • Updates on credentialing status within 24 hours
  • Payments from third-party payers arrive much quicker
  • Major medical provider enrollment; Medicare and Medicaid enrollments for group and individuals

Download our Credentialing brochure.

Request Credentialing

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Service Options and Details

Download the pdf of our Credentialing Services here. Pricing is available through your PrognoCIS service representative.

New Credentialing Includes:

  • Completion of all required application(s) to include EFT and ERA set up
  • Updating of CAQH (only for existing profiles)
  • Contracting with networks (does not include negotiations)
  • Access to credentialing updates within 24 hours of request
  • Follow up on process with insurance company
  • Facilitation of entire process from start to finish
  • Includes the credentialing AND contracting process.

Medicare Group Enrollment:

  • Medicare group enrollment is required for any practice that has a Tax ID that is used for billing.
  • If a group already has a Group PTAN (Provider Transaction Access Number) then the group is already credentialed with Medicare. In this case, a group enrollment is not necessary. However, if the PTAN is not valid then enrollment will be required.
  • The only time a provider does NOT need a group enrollment with Medicare is if the single provider is using SSN for billing and NOT a Tax ID.
  • If a group enrollment is necessary, then an individual enrollment will be necessary for all providers in the group. This is true even if there is only one provider.
  • Medicare group enrollment is state specific.

Medicare Individual Enrollment:

  • Providers must have an individual Medicare PTAN to bill Medicare.
  • Medicare Individual enrollment is state specific.
  • If a Provider has an individual Medicare PTAN then the provider is already credentialed with Medicare and an individual enrollment is not necessary. However, if the provider is joining another group the provider will require re-assignment. Reassignment does not terminate any existing groups to which they are currently assigned.
  • Reassignments are charged per application for each group requiring re-assignment.
  • If PTAN is not valid, then enrollment will be required.

Medicare Revalidations:

  • Medicare requires a provider to revalidate every 3 to 5 years. The provider will be notified by Medicare by letter stating exactly what revalidation needs to be completed.

Medicaid Group Enrollment:

  • Medicaid Group enrollment varies by state. If the state requires group enrollment then group enrollment will be required in addition to each individual provider enrollment.
  • Medicaid enrollment is state specific.

Medicaid Individual Enrollment:

  • If the specific state requires Group enrollment, then all providers in the group will also require individual enrollment.
  • Medicaid enrollment is state specific.

Re-Credentialing Includes:

  • Completion of all required application(s)
  • Facilitation of entire process from start to finish
  • Follow up on process with insurance company

Demographic Updates include:

  • Updating information from address, phone number, fax number, etc.
  • Tax ID and NPI updates
  • Facilitation of entire process

Add location includes:

  • Adding new location information
  • Completion of all paperwork
  • Follow up on process from start to finish

Medicare and Medicaid Enrollments include:

  • Completion of all enrollment forms (including EFT and contract paperwork)
  • Facilitation of entire process from start to finish

Yearly maintenance includes:

  • Tracking of the following documents expiration dates
    • Medical License
    • DEA/CDS
    • Board Certs
    • CEU’s
    • Anything with an expiration date (i.e. CPR certs, etc.)
    • Notification of re-credentialing dates
  • Updating of CAQH
  • Updating of NPI (group and individual)

**Prices do not include fees charged by the insurance company. Those fees may be paid to the network directly.**