Medicare & Medicaid Credentialing

Medicare and Medicaid credentialing are much like credentialing with commercial payers. There are a few things to be aware of, especially when treating patients from multiple states. This video mentions the often overlooked details.
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[@happysoul46]

Perfect!! This is always a confusing question in the office and your video made it very clear.

[@navigatingthebusinessofmed8251]

Glad it was helpful!

[@womanofgodchrissannie2207]

Thank you, great explanation and greatly appreciated.

[@navigatingthebusinessofmed8251]

Glad it was helpful! Thank you for watching!

[@MedicalBillingMaven]

In my experience, participating providers can see patients who have original medicare regardless of where the patient is from as long as they are from the 50 states , the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands even if the provider is not credentialed in their state. I believe they provider will only have to credential or submit updates for another state if they relocate to a new state within a different region or add a location. For me also, Medicaid like you said is per state. Great video as always. I love the topics you cover. 😊

[@navigatingthebusinessofmed8251]

Thank you for watching!

[@chhinderpalsingh5298]

Knowledgeable

[@navigatingthebusinessofmed8251]

Thank you for watching!

[@GiannaFalco-ji5qc]

Quick question, In terms of the medicare and medicaid plans. I am in NJ and our practice is in NJ. If your saying we need to credential our providers in medicare PA and NY (which are our surrounding states) do they need to be licenses in those states, even though they are only practicing in NJ but seeing patients that are from PA? Also, how can I become in network with horizon NJ health & all of the community plans. It seems impossible.

[@navigatingthebusinessofmed8251]

Providers only need licenses in the states in which they physically practice. For the surrounding states, you need to go onto PECOS and submit separately for each state in which you want to be able to bill Medicare. I am sure this is a common situation up there since everything is so close and patients cross state boarders often. You can always call your MAC (Medicare Administrative Contractor) to find out what to do/what is needed for this. I have never done credentialing for that area, but maybe Medicare and Medicaid plans have a special workflow/requirement for these situations. It is always worth calling Provider Relations. NJ Health and the other community plans should be just like all others in regards to getting credentialed and contracted. Check out their website for "new providers"/"Join Our Network"- here is the link you can try: www.horizonnjhealth.com/for-providers/provider-recruitment Good luck and thanks for watching!

[@m.fazalsialvee]

Hi can you please guide credentialing process of BCBS Illinois if the group and provider is Already credentialed but not linked to the tax id

[@navigatingthebusinessofmed8251]

Hi there. The group has to be registered with the insurance using the correct TIN and then a contract would be furnished with this information. Providers have to be affiliated with the group and you will have to check with the specific payer yo find out what they need to register the group and affiliate the provider to the group. Good luck!

[@varghesedatamatrix2701]

Hi Jennifer... we are group having 30 to 40 different doctors and NPs/PAs ...we want to credentialize them to Medicare and Medicaid in Texas...can we do it for them online through our group login ID...please advise..thanks

[@navigatingthebusinessofmed8251]

All Medicare applications are done via PECOS online. You can either submit the application online (faster) or print it and mail it off to Medicare per the application instructions. The group has to be approved before you can assign any of the providers to the group via PECOS. Medicaid has a separate application and you would need to look on the Medicaid of Texas website to find out what they require, but the group will need to be registered and approved as well, but they may allow you to do this simultaneously while listing/affiliating the providers under the group. Every payer is different so I’m not sure of their specific process. I would call if the website doesn’t provide the information on their process and requirements, especially if the providers are not yet credentialed with Medicaid of Texas. Texas has a lot of their own requirements for billing so you definitely want to make sure that you are doing everything the way they require because they can be different from other states.

[@TammyJeter-en4rj]

I have so many CRNA's and Anesthesiologists that do not know their numbers. Do you have any instructions on how to obtain your Medicaid and Medicare numbers?

[@navigatingthebusinessofmed8251]

Hi there! Thanks for asking. If you have access to PECOS you can obtain Medicare PTANs there. The provider will have a PTAN for each entity they are linked to so if they work multiple places, they will have one for each. Medicaid portals also usually provide Provider ID numbers and you can find them there if they are affiliated with the practice. If not, you would have to call Medicaid to find out what they are and also see if they are also assigned a number at each location their affiliated, or if they have one for the life of their career that they use their entire career. Good luck!

[@varghesedatamatrix2701]

Thanks

[@navigatingthebusinessofmed8251]

You’re welcome! Thank you.

[@Godisreal344]

Hi, i am credentialed with Medicare and Medicaid with my current job. I started my own practice....do i need to reapply for Medicaid and Medicare?

[@navigatingthebusinessofmed8251]

Hi there! Your new practice/business will need to be recognized by both Medicare and Medicaid to be considered in-network, even if you plan on billing as a sole proprietor. You will be affiliated to the group as the owner, so if you’re due for recredentialing then they will tell you. I hope this helps and good luck!

[@tanishaclayton8431]

Question: I have to service 10 clients for free in order to obtain cms accreditation. What is the best way to do this

[@navigatingthebusinessofmed8251]

Hi there and thank you so much for your question. I was hoping you could provide a little bit more information about the type of business that you have and why they’re requiring this. Are you a supplier of some sort? I am not familiar with this, so I am guessing it has something to do with a situation I have never Had the pleasure of working with Medicare on.

[@gachalevi233]

Should you get credentialed with Medicare first then Medicaid or can you apply for credentialing with these two at the Same time

[@navigatingthebusinessofmed8251]

You can do both at the same time and that is what I would do! Thanks for asking and for watching.

[@gachalevi233]

@@navigatingthebusinessofmed8251 thank you

[@kiac1857]

Hello! Are you familiar with Remote Intraoperative Neurodianostic monitoring? Referring to enrolling the provider in Medicare?

[@navigatingthebusinessofmed8251]

I am somewhat familiar with Remote Patient Monitoring (RPM), is is along those lines? I believe only medical doctors and mid-level practitioners are able to do that, so they would need to have their own TIN and PTAN to get a contract.

[@kiac1857]

Thanks for the response, it was helpful!