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PROVIDER ENROLLMENT SERVICE
PACKAGE FOR ALL PROVIDER TYPES
Provider Enrollment is the process of enrolling a provider with insurance payers, including Medicaid, Medicare, MCOs, and private/third-party insurance, so that they can request payment from those payers. Provider Enrollment process ensures that a provider gets approved to participate in an insurance network, and establishes the provider's eligibility to bill a particular payer.
Provider Credentialing is typically done before a healthcare provider is allowed to participate in an insurance network. Provider credentialing ensures claims don't get denied.
OUR PROVIDER ENROLLMENT SERVICE IS ONLY AVAILABLE TO LICENSED PROVIDERS & THOSE FOR WHOM LICENSURE IS REQUIRED BY THEIR STATE
ABOUT PROVIDER ENROLLMENT
GET ENROLLED AS A PROVIDER
MEDICAID PROVIDER ENROLLMENT
What You Get:
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MEDICAID APPLICATION PREPARATION: We help clients complete and submit the necessary Medicaid provider applications, ensuring that all required information is accurate and up-to-date.
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FOLLOW-UP COMMUNICATION: We liaise with Medicaid agencies on behalf of our clients, facilitating communication and addressing any inquiries or requests for additional information during the enrollment process.
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PROVIDER CREDENTIALING: We assist clients in the credentialing process, which may involve verification of qualifications, background checks, and ensuring compliance with Medicaid provider standards.
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MEDICAID BILLING SETUP: We help clients set up their billing systems and procedures to ensure accurate and efficient claims processing and reimbursement.
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MEDICAID COMPLIANCE: We provide guidance on Medicaid compliance requirements, helping clients understand and meet the regulatory standards necessary for provider enrollment.
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PROVIDER EDUCATION: We offer training and education to help clients stay informed about changes in Medicaid regulations and requirements.
MEDICARE PROVIDER ENROLLMENT
What You Get:
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MEDICARE APPLICATION ASSISTANCE: We guide clients through the Medicare provider application process, ensuring all necessary forms are completed accurately and submitted on time.
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DOCUMENT PREPARATIOIN: We help gather and organize the required documents and credentials, such as licenses, certifications, and insurance, to meet Medicare's standards.
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COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with all Medicare regulations and requirements, including the Centers for Medicare & Medicaid Services (CMS) guidelines.
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CREDENTIALING SUPPORT: Our team assists with the credentialing process, including the enrollment of individual healthcare providers to ensure they can bill Medicare for services.
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BILLING SYSTEM SETUP: We help clients establish effective billing systems and procedures to submit claims to Medicare accurately and efficiently.
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
What You Get:
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INSURANCE VERIFICATION: We help healthcare agencies determine which private insurance payers they should enroll with based on their services and target patient population.
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APPLICATIOIN ASSISTANCE: We guide clients through the application process for each selected private insurance payer, ensuring all required forms and documents are completed accurately and submitted on time.
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CREDENTIALING SUPPORT: We assist with the credentialing process, ensuring that individual healthcare providers within the agency are properly enrolled with private payers to bill for services.
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DOCUMENT PREPARATION: We help gather and organize the necessary documents and credentials, such as licenses, certifications, and insurance, to meet each private payer's standards.
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COMPLIANCE GUIDANCE: We ensure that healthcare agencies are compliant with the specific requirements and regulations of each private insurance payer.
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BILLING SYSTEM SETUP: Our team helps clients establish effective billing systems and procedures to submit claims to private payers accurately and efficiently.
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.
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Our Provider Enrollment services are designed to empower service providers with right tools and relationships to get paid for services they provide.