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PROVIDER ENROLLMENT SERVICES: MEDICAID-MEDICARE-MCO-PRIVATE PAYERS
Provider enrollment is a critical step in securing reimbursements from Medicaid, Medicare, Managed Care Organizations (MCOs), and private insurers. Without proper enrollment, healthcare providers risk delays in payments or even denials.
Our enrollment specialists simplify the complex enrollment process, ensuring accuracy, compliance, and timely approvals so you can focus on delivering exceptional care.
WHY PROVIDER ENROLLMENT MATTERS
Provider enrollment is more than just paperwork—it’s the gateway to your revenue stream. Whether you’re enrolling in Medicaid, Medicare, or private payer networks, errors or delays can result in lost income and operational setbacks.
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Medicaid : State-specific requirements can be overwhelming without expert guidance.
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Medicare : Navigating PECOS and CMS-855 forms requires precision.
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Private Payers & MCOs : Credentialing and contracting demand attention to detail.
At Waiver Consulting Group, we handle every aspect of the enrollment process, ensuring compliance and minimizing disruptions.
Preguntas más frecuentes
ABOUT PROVIDER ENROLLMENT
OUR PROVEN 5-STEP PROVIDER ENROLLMENT PROCESS
2. DOCUMENT PREPARATION FOR PROVIDER ENROLLMENT
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What We Do: Compile & Cross-reference Required Documents
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How We Do It:
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Gather licenses, tax IDs, formation documents, ownership agreements, and certifications.
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Cross-check for accuracy and completeness.
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Develop policy manual and organize everything else in a clear, submission-ready format.
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Common Enrollment Mistakes We Help You Avoid
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Heads up: Avoid These Common Pitfalls
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Our Tips :
Ready to Simplify Your Provider Enrollment? Let Us Handle the Process for You!-
❌ Incomplete Applications : Resulting in delays/rejections.
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❌ Credentialing Errors : Causing denied payments.
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❌ Missed Licensure/Certifications : Leading to compliance violations.
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📞 Call Now : (302) 888-9172
📧 Email Us : licensing@waivergroup.com
📅 Schedule Your Free Consultation Today!
MEDICAID PROVIDER ENROLLMENT
What You Get:
Medicaid Provider Enrollment
Medicaid enrollment is often the most complex due to state-specific regulations and frequent updates. Our team ensures your application is error-free, compliant, and submitted on time.
What We Do:
✅ State-Specific Medicaid Applications
Each state has unique Medicaid requirements, including pre-application training, fingerprinting, site visits, or additional certifications. We ensure full compliance with your state’s regulations.
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Example : In New York, Medicaid requires a Certificate of Need (CON) for certain provider types. We guide you through this process.
✅ Documentation Creation, Review & Submission
We collect, review, and organize all required documentation, including policy and procedure manual, licenses, tax IDs, and ownership agreements. Missing or incomplete documents are the #1 reason for delays—we eliminate this risk.
✅ Background Checks & Fingerprinting (Where Required)
Some states require background checks and fingerprinting for key personnel. We coordinate these processes to ensure they’re completed efficiently.
✅ Credentialing & Billing Setup
Once enrolled, we assist with credentialing and billing setup to ensure you can start receiving reimbursements as soon as possible.
✅ Managed Care Organization (MCO) Contract Assistance
Many states require providers to contract with Managed Care Organizations (MCOs) to serve Medicaid beneficiaries. We help you navigate MCO contracts and secure favorable terms.
📌 Why Choose Us for Medicaid Enrollment?
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Expertise in State Regulations: Our team stays up-to-date on state-specific Medicaid requirements.
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Error-Free Submissions: We minimize rejections by ensuring 100% accuracy.
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Faster Approvals: Our streamlined process reduces approval times by up to 30%.
MEDICARE PROVIDER ENROLLMENT
What You Get:
Medicare Provider Enrollment
Medicare enrollment involves navigating the Provider Enrollment, Chain, and Ownership System (PECOS) and completing CMS-855 forms. Errors or omissions can lead to costly delays.
What We Do:
✅ Guidance Through PECOS (Provider Enrollment, Chain, and Ownership System)
PECOS is the online system used to enroll in Medicare. We guide you through account setup, policy development, data entry, and submission.
✅ CMS-855 Forms Completion
The CMS-855 series of forms (e.g., CMS-855I for individual providers, CMS-855B for group practices) are notoriously complex. We complete these forms accurately and efficiently.
✅ NPI (National Provider Identifier) Registration
Every provider needs an NPI to bill Medicare. If you don’t already have one, we’ll register you quickly.
✅ Medicare Revalidation Assistance
Medicare requires providers to revalidate their enrollment information every five years. We ensure your data stays up-to-date to avoid payment disruptions.
✅ Billing & Compliance Setup
After enrollment, we assist with claims submission, EDI setup, and ongoing compliance monitoring.
💡 Medicare Enrollment Tip:
Medicare providers must periodically revalidate their enrollment information. We ensure your data stays up-to-date to avoid payment disruptions.
📌 Why Choose Us for Medicare Enrollment?
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Deep Knowledge of CMS Requirements: We know exactly what Medicare looks for in applications.
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Proactive Revalidation Support: We remind you when it’s time to revalidate and handle the process for you.
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Avoid Costly Delays: A single error can delay your enrollment by months—we eliminate this risk.
INDIVIDUAL APPLICATION:
The CMS-855I is the paper application for Physicians and Non-Physician Practitioners. This application is for initial enrollment in the Medicare program or changes to your existing Medicare record. The application is 27 pages and is processed by the Medicare Administrative Contractor (MAC) responsible for managing the jurisdiction in which you are applying. There are 12 different MACs managing CMS programs across the country. It is important that your application be submitted to the MAC responsible for your state.
PRIVATE PAYER/
INSURANCE ENROLLMENT / MCOs
What You Get:
Private Insurance & MCO Enrollment
Enrolling with private payers and Managed Care Organizations (MCOs) is essential for expanding your patient base and revenue streams. However, the process can be time-consuming and confusing.
What We Do:
✅ Identify & Apply to Private Payers & MCOs
We identify the best private payers and MCOs for your practice and manage the entire application process.
✅ Contract Negotiation & Credentialing
We negotiate favorable contract terms and ensure your credentials are verified by payers.
✅ Insurance Paneling & Billing Setup
Once credentialed, we assist with paneling and billing setup to ensure you can start receiving payments immediately.
✅ Recredentialing & Compliance Assistance
Private payers require periodic recredentialing. We handle this process to ensure continuous eligibility.
📌 Major MCOs & Private Insurers We Work With
We assist with enrollment for major MCOs and private insurers nationwide, including:
UnitedHealthcare
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Overview :
UnitedHealthcare is one of the largest health insurers in the U.S. and operates as part of UnitedHealth Group. It serves Medicaid, Medicare Advantage, and commercial populations. -
States Covered :
Operates in nearly all 50 states, with significant Medicaid and Medicare Advantage footprints. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Dual Eligible Special Needs Plans (D-SNPs)
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Anthem (Elevance Health)
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Overview :
Anthem, now rebranded as Elevance Health, is a major player in the managed care space. It operates under various brand names depending on the state (e.g., Anthem Blue Cross, Empire BlueCross BlueShield). -
States Covered :
Active in over 40 states, including large Medicaid and Medicare Advantage programs. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Commercial Insurance
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Centene Corporation
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Overview :
Centene is a leading Medicaid-focused MCO and also serves Medicare Advantage and commercial populations. It has expanded rapidly through acquisitions. -
States Covered :
Operates in nearly all states, with a strong focus on Medicaid and dual-eligible populations. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Marketplace Exchange Plans
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Humana
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Overview :
Humana is a Fortune 50 company with a strong focus on Medicare Advantage and dual-eligible populations. It also offers Medicaid managed care in select states. -
States Covered :
Operates in over 40 states, with a dominant presence in Medicare Advantage. -
Key Programs :
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Medicare Advantage
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Dual Eligible Special Needs Plans (D-SNPs)
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Medicaid Managed Care
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Aetna (a CVS Health Company)
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Overview :
Aetna is a major insurer offering Medicaid, Medicare Advantage, and commercial plans. It was acquired by CVS Health in 2018, further expanding its reach. -
States Covered :
Operates in over 40 states, with significant Medicaid and Medicare Advantage programs. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Commercial Insurance
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Cigna
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Overview :
Cigna is a global health services organization that provides Medicaid, Medicare Advantage, and commercial insurance. While it is more prominent in commercial markets, it has expanded into government programs. -
States Covered :
Operates in over 30 states, with growing Medicaid and Medicare Advantage programs. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Commercial Insurance
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Molina Healthcare
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Overview :
Molina Healthcare specializes in serving low-income populations through Medicaid and Medicare Advantage programs. It has a strong presence in underserved communities. -
States Covered :
Operates in over 15 states, but its Medicaid focus makes it a key player in those markets. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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WellCare (Part of Centene Corporation)
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Overview :
WellCare was acquired by Centene in 2020 and remains a significant brand for Medicaid and Medicare Advantage programs. -
States Covered :
Operates in over 30 states, with a focus on government-sponsored programs. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Dual Eligible Special Needs Plans (D-SNPs)
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Kaiser Permanente
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Overview :
Kaiser Permanente is a vertically integrated healthcare system that combines insurance and provider services. While it is not present in all states, it operates in key regions with large populations. -
States Covered :
Operates in 8 states and Washington, D.C., with a strong focus on Medicaid and Medicare Advantage. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Blue Cross Blue Shield Association (BCBSA)
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Overview :
The Blue Cross Blue Shield Association is a network of independent, locally operated BCBS plans. Collectively, BCBS plans operate in all 50 states. -
States Covered :
Every state has at least one BCBS plan, making it a truly national presence. -
Key Programs :
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Medicaid Managed Care
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Medicare Advantage
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Commercial Insurance
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Other Notable MCOs
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Magellan Health: Focuses on behavioral health and specialty health services, operating in multiple states.
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CareSource: A Medicaid-focused MCO with operations in several states.
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AmeriHealth Caritas: Operates Medicaid and Medicare Advantage programs in multiple states.
📌 Why Choose Us for Private Insurance & MCO Enrollment?
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Broad Network Access: We help you enroll with multiple payers simultaneously.
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Negotiation Expertise: We secure the best possible rates for your services.
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Ongoing Support: We monitor deadlines and handle recredentialing to keep you compliant.
ACHC ACCREDITATION
What You Get:
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INITIAL ASSESSMENT: We conduct a comprehensive assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet ACHC standards.
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POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with ACHC accreditation standards.
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STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement ACHC compliance requirements effectively.
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MOCK SURVEYS & READINESS REVIEW: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official ACHC accreditation survey.
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DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets ACHC standards for submission.
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ACCREDITATION APPLICATION ASSISTANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.
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ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by ACHC surveyors.
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SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.
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CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with ACHC standards after accreditation is achieved.
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CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.
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ACCREDITATIOIN RENEWAL: We help agencies prepare for the renewal of their ACHC accreditation, ensuring continued compliance.
THE JOINT COMMISSION ACCREDITATION
What You Get:
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INITIAL ASSESSMENT: We conduct a thorough assessment of the healthcare agency's current operations and policies to identify areas that need improvement to meet The Joint Commission standards.
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POLICY & PROCEDURE DEVELOPMENT: We assist in the development and customization of policies and procedures to align with The Joint Commission's accreditation standards.
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STAFF TRAINING: We provide training programs for agency staff to ensure they understand and can implement The Joint Commission's compliance requirements effectively.
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MOCK SURVEYS & READINESS REVIEWS: We conduct mock surveys and readiness reviews to prepare healthcare agencies for the official Joint Commission accreditation survey.
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DOCUMENTATION REVIEW: We review and organize all required documentation, ensuring it meets The Joint Commission's standards for submission.
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ACCREDITATIOIN APPLICATION ASSITANCE: We assist in completing the accreditation application, ensuring that all necessary information is included.
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ONSITE SURVEY PREPARATION: We help healthcare agencies prepare for the onsite survey conducted by Joint Commission surveyors.
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SURVEY SUPPORT: We offer support during the official accreditation survey, assisting in responding to surveyor inquiries and addressing any concerns.
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CONTINUOUS COMPLIANCE MONITORING: We provide ongoing support to maintain compliance with The Joint Commission's standards after accreditation is achieved.
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CORRECTIVE ACTION PLANS: If deficiencies are identified during the survey, we assist in developing and implementing corrective action plans to address them.
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ACCREDITATION RENEWALS: We help agencies prepare for the renewal of their Joint Commission accreditation, ensuring continued compliance.
Service Package for new entrepreneurs. We launch your agency from A - Z without you lifting a finger.
Service Package For All Provider Types. Helping to establish strong branding and presence.
Service Package For All Provider Types. Guidance on navigating complete regulatory landscape.
Service Package for Providers or Franchises Already In Operation. Design & Service Utilization guide.
Service Package For All Provider Types. Knowledge & Skill development for agency team.
Whether you're looking to start up or expand, our 20 years of comprehensive service got you.
Contact Us
Our Provider Enrollment services are designed to empower service providers with right tools and relationships to get paid for services they provide.